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Abad
Following taken from PPT from Section A, B, C and D (Thanks to James Co, Jill D., Cesar, and Pasky for getting the ppt I didn’t get in class). Previous notes taken from Chok’s reviewer.
Props to all of ya’ll who hammered some questions during the shifting week: Florida Gators for National Championship in basketball and football. Go Gators. Thanks to Ryan Go for the
additional notes. Thanks to Melody for gathering A6-2010 together, Irish for doing some last min work, and the Fil-am Core of 2010. Also thanks to the Section A members who helped
out from our future neuro surgeon Pasky, da cute group, respiratory expert Nicole, and lastly the hidden ninja. What’s this music..it’s not the Oscars. Kidding…Good luck & God Bless.
Relationship between breathing and systolic blood pressure (1-3 by Jill Desquitado 4 by Ryan Chua)
1. Describe blood pressure waveform using an arterial catheter. Label the following; systolic blood pressure (SBP), diastolic blood pressure (DBP),
pulse pressure and mean arterial blood pressure (MAP).
Systolic BP: Max aortic pressure following ejection from the left ventricle (Psystolic), Corresponds to max arterial vol
Diastolic BP: Lowest pressure in the aorta just before the ventricle ejects blood into the aorta (Pdiastolic).
Mean Arterial Pressure (MAP): pressure of blood pumped out of the left ventricle into the arteries; equal to CO x TPR
Pulse Pressure: maximal change in aortic pressure during systole; SBP minus DBP
Arterial Catheter
An arterial catheter is a very small plastic tube placed in one of your blood vessels (an artery)
Pulse Pressure
Change in blood pressure seen during the contraction of the heart
Difference between systolic pressure and diastolic pressure
2. Review physiologic principle involved in the auscultatory method of blood pressure measurement.
Auscultatory Method
Practitioner listens with a stethoscope applied to the skin of the antecubital
space
Pressure in the bag exceeds the systolic pressure, brachial artery is occluded
No sounds are heard
When inflation pressure falls just below systolic pressure, a small spurt of
blood escapes the occluding pressure of the cuff
Korotkoff Sounds
Sounds heard through the stethoscope as the pressure cuff deflates.
First sounds = systolic pressure
Sounds cease to be heard once the cuff has deflated past the diastolic
pressure.
Vascular Compliance
ability of a blood vessel wall to expand and contract passively with
changes in pressure
ability of a vessel to distend
∆V
C=
∆P
4. Based on the previous guide questions, give the reason why the systolic blood pressure is lower during inspiration compared to expiration.
Inspiration: ↑ thoracic air space ↓ intrathoracic P ↑ intraabdominal P ↑ venous return ↓ systemic pressure ↑ pulmonary pressure ↑
blood volume in pulmonary circulation
Inspiration with bag: ↑ intrathoracic pressure ↓ venous return ↑ LA volume ↑ CO ↑ systemic pressure, ↓ pulmonary pressure, ↓ blood volume
in pulmonary circulation
Expiration: ↑ LA volume ↑ CO ↑ systemic pressure, ↓ pulmonary pressure, ↓ blood volume in pulmonary circulation
Nitroglycerine (5-6 by Ryan Chua, 7-9 by Jeffery Co/Irish, 10-12 by Micki Avancena)
5. Discuss the correct temporal relationship, the pressure, volume, heart sound, and ECG changes in the cardiac cycle. Identify the intervals of
isovolumic contraction, rapid ejection, reduced ejection, isovolumic relaxation, rapid ventricle filling, reduced ventricular filling and atrial
contraction.
6. Define the following: ejection fraction (EF), end diastolic volume (EDV), end systolic volume (ESV), and stroke volume (SV). Predict the change in
ejection fraction that would result from a change in a) preload, b) after load, and c) contractility.
• End Diastolic Volume (EDV) – Volume at the end of diastole (ventricular filling)
• End Systolic Volume (ESV) – Volume at the end of systole (ventricular contraction)
• Stroke Volume (SV)= EDV – ESV – volume of blood pumped out of one ventricle of the heart in a single beat
• Ejection Fraction = SV - percent of end-diastolic ventricular volume that is ejected with each stroke, SV/EDV
EDV
Effect on PV Loop
PRELOAD
Refers to the amount of end-diastolic stretch on myocardial muscle fibers
Determined by the volume of blood filling the ventricle at end-diastole
the greater the filling volume, the greater is the stretch
load of the heart prior to contraction (EDV)
AFTERLOAD
Refers to the sum of all the loads against which the muscle fibers of both ventricles must shorten in order to eject blood into the arterial
circulations
load that the heart pumps against with
CONTRACTILITY
Describes the inotropic state of the myocardium that relates to the velocity and extent of myocardial fiber shortening regardless of preload
and afterload
performance of the heart at a given preload and afterload
Summary:
↑ PRELOAD ↓ PRELOAD
↑ stroke volume ↓ stroke volume
↑ ejection fraction ↓ ejection fraction
↑ CONTRACTILITY ↓ CONTRACTILITY
↑ stroke volume ↓ stroke volume
↑ ejection fraction ↓ ejection fraction
↑ AFTERLOAD ↓ AFTERLOAD
↓ stroke volume ↑ stroke volume
↓ ejection fraction ↑ ejection fraction
7. Discuss the normal pressure volume loop. Discuss the change in pressure-volume loops that would result from changes in a) afterload, b) preload,
and c) contractility
Pressure-Volume Loop
Extrinsic Regulation of HR
Effects of:
a. afterload. Afterload is the pressure in the aorta that the left ventricle
needs to overcome in order to eject blood out of the heart. So:
increasing afterload will increase CD of the PVL
b. Preload. Preload is proportional to end diastoloic volume (until threshold). And will increase stroke volume. An increase in preload will also
increase ABC of PVL
c. Contractility. Will increase DEF
Diastolic filling starts at A, when the mitral valve opens, and it terminates at C, when the mitral
valve closes. The initial decrease in left ventricular pressure (A to B), despite the rapid inflow of
blood from the left atrium, is attributed to progressive ventricular relaxation and distensibility.
During the remainder of diastole (B to C), the increase in ventricular pressure reflects ventricular
filling and the changes in the passive elastic characteristics of the ventricle. Note that only a
small increase in pressure accompanies the substantial increase in ventricular volume during
diastole (B to C). The small pressure increase reflects the compliance of the left ventricle during
diastole. The small increase in pressure just to the left of C is caused by the contribution of atrial
contraction to ventricular filling. With isovolumic contraction (C to D), pressure rises steeply, but
ventricular volume does not change because the mitral and aortic valves are both closed. At D,
the aortic valve opens, and during the first phase of ejection (rapid ejection, D to E), the large
reduction in volume is associated with a steady increase in ventricular pressure. This volume
reduction is followed by reduced ejection (E to F) and a small decrease in ventricular pressure.
The aortic valve closes at F, and this event is followed by isovolumic relaxation (F to A), which is
characterized by a sharp drop in pressure. Ventricular volume does not change during the interval
from F to A because the mitral and aortic valves are both closed. The mitral valve opens at A to
complete one cardiac cycle.
(Fig 16-10)
Figure 16-10 Left atrial, aortic, and left ventricular pressure pulses correlated in time with aortic flow, ventricular volume, heart sounds, venous
pulse, and the electrocardiogram for a complete cardiac cycle in the dog.
PRELOAD
• lRefers to the amount of end-diastolic stretch on myocardial muscle fibers
• lDetermined by the volume of blood filling the ventricle at end-diastole
• lthe greater the filling volume, the greater is the stretch
AFTERLOAD
lRefers to the sum of all the loads against which the muscle fibers of both ventricles must shorten in order to eject blood into the arterial
circulations
Increased afterload in Left Ventricular Pressure Volume Loop
↓SV ↑ SV
↓EF ↑ EF
↑ESV ↓ ESV
Increase in Contractility on Left Ventricular Pressure Volume Decrease in Contractility on Left Ventricular Pressure Volume Loop
Loop
↑ SV ↓ SV
↑ EF ↓EF
↓ ESV ↑ ESV
8. Discussed the work done by the cardiac muscle in relation to the normal pressure volume loop of the heart.
Tension heat
= product of wall tension and length of time
= major determinant of the total energy requirement
9. Describe the phasic flow of blood to the ventricular myocardium through an entire cardiac cycle. Contrast this cyclic variation in myocardial flow
a) in the walls of the right and left ventricles and b) in the subendocardium and subepicardium of the left ventricle. Identify the area of the ventricle
most susceptible to ischemic damage and why the risk is increased at high heart rates.
Extravascular compression (EC) is the temporary halt in blood flow to the ventricular walls
brought about by the compression of blood vessels by the myocardium during contraction.
As a result, blood flow to the ventricular walls is highest at diastole (ventricular relaxation)
Blood supply to the epicardium is found superficial to the thick muscles of the heart and so,
is not affected by EC.
Therefore, blood flow to the epicardium is highest during systole while blood flow to the
endocardium is highest at diastole.
Increase in HR will increase contractions of the ventricular wall. Time for diastole will
decrease while systole will relatively increase making it more dangerous for the deeper
layers of the myocardium.
Normal Coronary Blood Flow
•Resting- 225 mL/min( 4-5% of total CO)
•Influenced by:
–Aortic pressure
–Extravascular compression
•Systole- ventricular contraction
•Diastole-ventricular relaxation
Contrast this cyclic variation in myocardial flow a.) in the walls of the right and left ventricles
LEFT HEART RIGHT HEART
Early Systole-great Systole-develop lower pressure
force of extravascular compression (blood flow is reversed) -constitutes a much greater proportion of
Early Diastole-maximal coronary inflow coronary inflow
stronger compression of LEFT ventricular muscle Diastole
Identify the area of the ventricle most susceptible to ischemic damage and why the risk is increased at high heart rates
ISCHEMIA- insufficiency of blood supply
Acute coronary occlusion
Myocardial Infarction
SUBENDOCARDIAL SURFACE
-greatest: left ventricular myocardial pressure
-blood vessels are intensely compressed (systolic contraction) extra difficulty obtaining adequate blood flow
10. Compare the excitation contraction coupling of a cardiac and vascular smooth muscle.
rapid and of relatively short duration contractions slow, sustained, tonic contractions
contains actin and myosin WITH troponin contains actin and myosin WITHOUT troponin
Free calcium in the cytoplasm binds to protein troponin C Free calcium binds to protein calmodulin
Ca++ - troponin complex interacts with tropomyosin to Ca++-calmodulin complex activates MLCK and
unblock active sites between actin and myosin phosphorylates MLC in the presence of ATP
The unblocking initiates cross-bridge cycling and hence MLC phosphorylation leads to cross-bridge formation
CONTRACTION occurs between myosin heads and actin and hence,
CONTRACTION occurs
has T-tubules, troponin, fast Na channels lacks T-tubules, troponin, fast Na channels
close association bet. Action potential and contraction no close association bet. Action potential and contraction
electromechanical coupling-Ca
pharmacomechanical coupling (predominant)
11. Discuss the receptors found in a vascular smooth muscle. By what mechanism can arterial smooth muscle can be relaxed and promote
vasodilatation.
•PERIPHERAL CHEMORECEPTORS
–Small highly vascular bodies
–Located in the region of the aortic arch (AORTIC BODIES) and just MEDIAL TO THE CAROTID SINUSES (CAROTID BODIES)
–Sensitive to changes in PO2, PCO2, pH of blood
- ↓ PaO2 → aortic and carotid body stimulation → VASOCONSTRICTION
- Increases tone and capacitance of vessels
- Can also be found in CARDIAC MUSCLES
–Transmit PRECORDIAL PAIN associated with INADEQUATE BLOOD SUPPLY TO THE MYOCARDIUM
- SIMULTANEOUS occurrence of HYPOXIA and HYPERCAPNIA à enhanced chemoreceptor stimulation
A.Myogenic Mechanism
•Vascular smooth muscle contracts in response to an increase in pressure difference across the blood vessel wall (transmural pressure) and relaxes in
response to decrease in transmural pressure
B.NITROGLYCERIN:
1. Denitrated by Glutathione-S-transferase
2. Nitrite release converts nitroglycerin to NITRIC OXIDE (NO)
3. NO activates guanylyl cyclase
4. Formation of cyclic guanosine monophosphate (cGMP)
5. cGMP activates protein kinase A
6. phosphorylation of MLCK with subsequent dephosphorylation of myosin light chain and Ca ion release
7. Relaxation = VASODILATION
α-adrenergic receptors
- would be bound with
Norepinephrine (NE) activating the Vasodilatory and Vasoconstictory Mechanisms in Vascular Smooth Muscle
Phospholipase C causing formation 1. Autonomic nervous System
of IP3 w/c in turn stimulates Vasodilation: through Epinephrine
release of Ca2+ from SR ----- Vasoconstriction: through Norepinephrine
vasoconstriction
ß2-adrenergic receptor 2. Vascular Receptors
-would be bound with Epinephrine Vasodilation: ß2-adrenergic
resulting to inc. cAMP leading to stimulation, adenosine, and
dec. Ca2+ ----- vasodilation prostacyclin
AII receptor Vasoconstriction:α-adrenergic
-would be bound to AngiotensinII stimulation
activating the Phospholipase C causing formation of IP3 w/c 3. Messenger systems
in turn stimulates release of Ca2+ from SR ----- vasoconstriction Vasodilation: receptors via G proteins to Adenylate cyclase
forming cAMP until myosin-light chain kinase is inhibited
ETa receptor Vasoconstriction: recptors… G-proteins…phospholipase C… IP3 and PKC…
- would be bound to Endothelin-I contractile proteins
activating the Phospholipase C 4.Endothelium
causing the formation of IP3 w/c vasodilation: EDRF (NO)--guanylate cyclase—formation of cAMP
in turn stimulates release of Ca2+ vasoconstriction: through Endothelin
from SR ----- vasoconstriction
12. Summarize the results of the intervention with regards the MAP and HR. Give the physiologic explanation of the result. Discuss the changes in
the ejection fraction, end diastolic volume, end systolic volume, stroke volume and pressure volume loop with this intervention.
Nitroglycerine = relaxation of vascular smooth muscle by forming NO ↑ cGMP myosin light chain dephosphorylation
• ↓ HR
• ↓ MAP due to ↓ preload ↓
Effect of Nitroglycerin
–Vasodilation of central arteries and veins
–Decrease Mean Arterial Pressure
–Decrease Preload
–Increase After load
–Increase Contractility
–Increase Heart Rate
•ejection fraction decreased
•end diastolic volume decreased
•end systolic volume increased
•stroke volume decreased
13. Contrast the sympathetic and parasympathetic branches of the autonomic nervous system based on: spinal cord division of origin, length of
preganglionic and postganglionic neurons, neurotransmitters and receptors at the ganglionic and target organ synapse.
The autonomic nervous system includes the sympathetic and parasympathetic nervous system, wherein the sympathetic NS is for fright,
flight and fight response and the PNS for rest and digest mechanisms. Also, enteric NS comprises the ANS, which are intramural plexuses of the GI
tract. It receives input from SNS and PNS, but it can act independently.
SNS and PNS consist of cell bodies found in the CNS that will send its myelinated preganglionic fiber to the autonomic ganglion. From this
ganglion, an unmyelinated postganglionic fiber will supply the specific targets.
Sympathetic Parasympathetic
Pregang Postgang Pregang Postgang
Intermediolateral cell Prevertebral and CN III, VII, IX, X and sacral terminal ganglia in or near
SC origin (location of column in the thoracic and Paravertebral ganglion spinal cord (S2-4) target organ
neuron cell bodies) upper lumbar segments of
the SC
Length Shorter Longer Longer Shorter
NT Ach NE Ach Ach
1° postsynaptic receptor Nicotinic Adrenergic (α, β) Nicotinic Muscarinic
Myelination Yes No Yes No
14. Contrast epinephrine from norepinephrine with regards their site of release and affinity to receptors. Discuss the actions of the sympathetic
and parasympathetic system in the different organs.
Norepinephrine
Bulk is produced by sympathetic postganglionic fibers
Effects are mediated directly by the sympathetic nervous system
Epinephrine
Produced exclusively by the adrenal medulla
Effects are brought about exclusively by the adrenal medulla
Secretion always accompanies a generalized sympathetic nervous system discharge
Norepinephrine is primarily produced by the postganglionic sympathetic fiber and is mediated by the sympathetic NS. Epinephrine, on the
other hand, is exclusively produced by the adrenal medulla and its secretion always accompanies a generalized sympathetic response. Also,
norepinephrine produced by subsequent action of different enzymes on tyrosine can be converted to epinephrine through the action of
phenylethanolamine N-methyltransferase, which uses S-adenosylmethionine as the methyl donor.
The endocrine cells of the adrenal medulla receive input fom sympathetic preganglionic neurons, are excited by acetylcholine, and release
catecholamines. However, the main catecholamine released is epinephrine. In humans, 80% of the catecholamine released by the adrenal medulla is
epinephrine and 20% is norepinephrine.
α receptors • Calorigenesis
Vasoconstriction, dilation of the iris, contraction of the ADRENEGIC LOCATION AFFFINITY OF TYPICAL EXAMPLES OF
intestinal and bladder sphincter, and contraction of the RECEPTOR CATECHOLAMINE RESPONSE RESPONSES
pilomotor muscles TYPE FOR NE AND E ELICITED ELICITED
α1 receptors Postsynaptic; NE > E Excitatory Generalized
Located postsynaptically α1 Most arteriolar
effects are mediated by activation of the inositol triphosphate/ sympathetic vasoconstriction
diacylglycerol second messenger system target cells (↑ smooth
muscle
Ca along with PKC mediates the hormone effects
contraction)
α2 receptors Presynatic or NE > E Inhibitory Decreased
either presynaptic or postsynaptic α2 postsynaptic; motility in
autoreceptors – receptors located presynaptically; inhibit Digestive digestive tract
transmitter release system (↓smooth
decrease rate of synthesis of cAMP though an action on a G muscle
protein contraction)
β receptors Heart NE = E Excitatory Increased rate
Subdivided on the basis of the ability of antagonists to block β1 and strength of
them cardiac muscle
Protein that make up the receptors is composed of seven contraction
membrane spanning regions connected by intracellular and Skeletal E only Inhibitory Breakdown of
extracellular domains β2 muscle; glycogen in
smooth skeletal
muscle of muscle;
Antagonized by the action of α1 receptors
some blood bronchiolar
β1 receptors
vessels and dilation and
• Increase heart rate organs arteriolar
• Increase heart contraction vasodilation in
β2 receptors skeletal muscle
• Skeletal muscle vasodilation and heart (↓
• Glycogenolysis smooth muscle
contraction)
• Bronchodilation
• Uterine relaxation
ORGAN Sympathetic Parasympathetic
Action Receptor Action Receptor
Eye
Iris Contracts α
Radial muscle - Contracts M3
Circular muscle Relaxes β Contracts M3
Ciliary muscle
Heart
SA node Accelerates β1> β2 Decelerates M2
Ectopic Pacemakers Accelerates β1> β2
Contractility Increases β1> β2 Decelerates M2
Blood Vessels
Skin, splanchnic Contracts α1
Skeletal muscle Relaxes β2
(Contracts) α1
Relaxes M3
Endothelium Releases EDRF ((NO)((NO) M3
Bronchiolar smooth muscle Relaxes β2 Contracts M3
GI
Smooth muscle
Walls Relaxes α2, β2 Contracts M3
Sphincters Contracts α1 Relaxes M3
Secretion Increases M3
Myenteric plexus Activates M1
GU
Bladder wall Relaxes β2 Contracts M3
Sphincter Contracts α1 Relaxes M3
Uterus, pregnant Relaxes β2
Contracts α Contracts M3
Penis, seminal vesicles Ejaculation α Erection M1
Skin
Pilomotor smooth Muscle Contracts
Sweat glands
Thermoregulatory Increases
Apocrine (stress) Increases
Metabolic
Liver Gluconeogenesis β2, α
Liver Glycogenolysis β2, α
Fat cells Lipolysis β3
Kidney Renin release β1
Autonomic nerve endings
Sympathetic Decreases NE release M
Pasympathetic Decrease Ach release α
15. Briefly describe the different signal transduction pathways. Discuss in detail which of these pathways is utilized by epinephrine and
neostigmine.
G-protein
Tyrosine Kinase Nitric Oxide ANP
cAMP Phosphoinositol Arachidonic acid
1° Messenger NE Ach Histamine
Receptor β-adrenergic mAchR Histamine TK receptor
Transducer Gα Gα Gβγ Dimerization
1° Effector AC PLC PLA2 Ras-activator protein GC GC
2° Messenger cAMP IP3 / DAG Arachidonic acid Ras protein cGMP cGMP
cAMP- Lipooxygenases, cGMP-dependent
2° Effector Ca release / PKC MAP kinases CHON kinases
dependent PK cyclooxygenase protein kinase
Paracrine mediator; From atrial cells,
Used by EGF, FGF, released by the
Notes Gs stimulatory, Gi inhibitory in response to ↑
NGF, BDGF & insulin endothelial cell;
membrane permeable atrial pressure
• Epinephrine – uses β-adrenergic receptor activates AC ↑ cAMP
• Neostigmine – anti-Achase prolongs Ach effect
16. State the relationship between blood flow, velocity and cross sectional area of a blood vessel. Discuss Ohm’s law and Reynold’s number.
V = Q/A where Q= blood flow; A= cross-sectional area
↑ velocity = ↑ blood flow ↓cross-sectional area
Ex. Blood flow velocity is higher in the aorta (small cross-sectional area) than in the sum of all the capillaries (large cross-sectional area). The lower
velocity of blood flow in the capillaries optimizes conditions for exchange of substances across the capillary wall.
OHM’s LAW – Q = ∆P where: Q = Blood flow; ∆P = pressure difference between the two ends of the vessel; R= resistance
R
↑ flow = ↑ pressure ↓resistance
17. Explain how Poiseuille’s Law influences resistance to flow. What will be the effect of epinephrine on these variables (blood flow, velocity and
cross sectional area of a blood vessel)? Will there be turbulent flow in the large blood vessels? Why?
R4 = this is powerful. For example if blood vessel radius decreases by a factor of 2 then resistance increases by a factor of 16, and blood flow
decreases by a factor of 16.
• Turbulent Flow
o Reynold’s Number (RE): measure of the tendency for turbulence to occur
o Turbulence occurs when: radius is large (aorta), ↑ Blood flow, RE > 3000
18. Summarize the results of the intervention with regards the pupils’ size, HR, MAP and intestinal movement. Discuss the physiologic basis for the
results.
Epinephrine causes sympathetic responses: ↑ pupil size, ↑ HR, ↑ MAP, ↓ intestinal movement
Parameter Receptors 2° Messenger Effect
Pupil size β Dilate papillary dilator muscle
HR β1 cAMP ↑ Phase 4 depolarization ↑ conduction velocity
↓ PR interval Accelerate
MAP α2 IP3/DAG Vasoconstriction ↑ TPR MAP
Intestinal Movement α2β2 cAMP Inhibited
Neostigmine (19-21 by Cesar Palana 22 by Marryann Chiombon, 23 by Donnabelle Chu 24 by Maylyn Cauilan)
19. Discuss the events involved in the synaptic transmission between a parasympathetic postganglionic axon and a target organ. Relate
neostigmine’s mechanism of action in your discussion.
SYMPATHETIC PARASYMPATHETIC
PRE POST POST PRE
ganglionic Ganglionic ganglionic ganglionic
20. Discuss a typical action potential in a ventricular muscle and a pacemaker cell, labeling both the voltage and time axes accurately. Describe
how ionic currents contribute to the four phases of the cardiac action potential.
Pacemaker vs Ventricular AP
Phase Notes
upstroke is less steep, SA & AV node do not have fast Na channels, voltage-sensitive Ca2+ channels open when threshold is reached,
0
depolarization mainly caused by slow influx of Ca2, low overshoot
1 early repolarization is absent
2 less sustained plateau phase
More gradual repolarization, Ca2+ channels rapidly inactivated soon after opened, ↓ Na+ permeability, ↑ K+ permeability, efflux
3
slowly repolarizes the cell
4 resting membrane potential (-55 to -60 mV [less negative]) due to leaky Na+ and Ca2+ channels
• Epinephrine = ↑ cAMP enhanced Ca2+ channels (Phase 2 of ventricular; Phase 0 of pacemaker) more rapid Ca2+ entry rapid AP &
contractions
• Neostigmine = ↑ Ach Ca2+ channel less likely to open (Phase 2) slower depolarization cell less excitable
o K+ channels remain open (Phase 3) hyperpolarization cell less excitable
21. Discuss the electrical attributes of action potential which determine the cardiac cell’s automaticity and conduction velocity.
22. Which phase or phases in the action potential can be altered by the neostigmine and epinephrine to produce an effect in the cardiac rate?
23. Discuss the physiologic events that correspond to the different waves and intervals that are seen in a 12 lead ECG. Which of these ECG waves
and intervals can be altered by neostigmine?
Neostigmine causes bradycardia and the following are seen in the ECG waves and intervals:
24. Summarize the results of the intervention with regards the pupils’ size, HR, MAP and intestinal movement. Discuss the physiologic basis for the
results.
Neostigmine = Parasympathetic
Parameter Effect Explanation
Pupil size ↓ Ach + M3 ↑ IP3/DAG ↑ Ca contraction
HR ↓ Ach + M2 ↓ AC ↓ cAMP ↓ contractility
MAP ↓ Ach + M ↑ Ca ↑ NO ↑ cGMP vasodilatation
Intestinal Movement ↑ Ach + M3 ↑ IP3/DAG ↑ Ca contraction
25. Stimulation of the sciatic nerve produced movements of the leg. Explain the physiologic events that occur from the motor fibers stimulation
till the contraction of the leg skeletal muscles.
Excitation-Contraction Coupling
Sequence: AP spreads over motor axon terminals Ca Influx Ach secretion Nicotinic receptor stimulation Na influx Depolarization
Dihydropyridine stimulation Ryanodine opening Ca release Muscle contraction
26. Differentiate the two types of motor unit. Which type of motor unit is usually recruited when the sciatic nerve is stimulated by low intensity of
electrical stimulus?
30. Summarize the results of the intervention with regards the respiratory rate and intrapleural pressure.
Parameter Effect Explanation
Respiratory rate Pain and emotional stimuli Afferents from limbic system and hypothalamus
↓
Ventilatory pattern Generator (Medulla) Motor neurons of phrenic nerves and
Intrapleural pressure ↑ intercostal nerves Contraction of the diaphragm and intercostal muscle
31. Explain the sequence of events mediated by cardiopulmonary (volume) receptors & baroreceptors that occur after an acute increase or
decrease in arterial blood pressure. Include receptor response, afferent nerve activity, CNS integration, efferent nerve activity to the heart, kidney,
hypothalamus, and vasculature.
Receptor Heart Vasculature Hypothalamus Kidneys Net Effect Via NTS to stimulate/inhibit
↑ MAP ↑ Arterial ↓ HR Vasodilation ( ↓ Preload) ↓ AVP release ↑ Urine ↓ BP (+)Vagal Nuclei &
Baroreceptors ↓ SV Venodilation ( ↓ TPR) (Pituitary) Formation Nucleus Ambiguus ↑
Parasympathetic
(-) Vasomotor Center ↓
Sympathetic
↓ MAP ↓ Arterial ↑ HR Vasoconstriction ( ↑ TPR) ↑ AVP release ↓ Urine ↑BP (-) Vagal Nuclei &
Baroreceptors ↑ SV Venoconstriction ( ↑ (Pituitary) Formation Nucleus Ambiguus ↓
Preload) Parasympathetic
(+) Vasomotor Center ↑
Sympathetic
↑ MAP (↑ ↑Volume receptor ↑ HR Vasodilation ↓ AVP (Post. ↑ Na, H20 ↓ blood (-)Vasomotor Center ↑
ECV) discharge ↑ ANP Pituitary) excretion volume (MAP) Sympathetic (SA Node) and ↓
Sympathetic
↓ MAP ↓Volume receptor ↑ HR Vasoconstriction ↑ AVP (Post. ↓ Na, H20 ↑ blood (+)Vasomotor Center ↑
(↓ECV) discharge ↓ ANP Pituitary) excretion volume (MAP) Sympathetic
↑ MAP stretch receptors (carotid & aorta) brainstem parasympathetic dominance vagus ↓ HR + vasodilatation
32. Summarize the results of the intervention with regards HR, MAP and urine output. Discuss the physiologic basis for the results.
Parameter Effect Explanation
HR Decrease Active baroreceptors, ↓ sympathetic, ↑ parasympathetic (SA Node)
MAP Increase ↑ ECV, ↑ preload, ↑ SV, ↑CO, ↑ MAP
Urine Output Increase ↓ RAAA & ADH + ↑ ANP & GFR
HR & MAP: Saline infusion ↑ ECF volume but no ICF/ECF water shift = volume expansion ↑ total blood volume ↑ venous return ↑ preload
↑ stroke volume ↑ cardiac output ↑ MAP reflex
Urine output: ↑ MAP water-losing mode = ↓ RAAA & ADH + ↑ ANP & GFR ↓ salt retention & ↑ water loss
Hemorrhage (33-34 by Karen Amoloza 35-36 by Bianca Arambulo 37-39 by Mike Castro 40 by Cathy Cifra)
33. Discuss and relate the mechanisms of hemostasis that come into play when vascular injury occurs.
34. Discuss the factors that control O2 transport and delivery to tissues? Speculate on what will happen to these factors during hemorrhage.
Hemorrhage
• Major Effects of Hypovolemia
• ↓ ECV
• ↓ MAP
• ↓ CO
• ↓ O2 delivery Hypoxia
• Main body response: ↑ MAP, CO & O2 delivery
Chemoreceptor Reflex
• ↓ RBC concentration ↓ Hemoglobin ↓ O2 transport Hypoxia O2 consumption > O2 perfusion
o Hyercapnia
o Hypoxia
o Activation of Chemoreceptors
• Response: ↑ Respiratory Rate
Baroreceptor Reflex
• ↓ MAP activation of baroreceptors (carotid & aortic baroreceptors)
• ↓ parasympathetic
• ↑ sympathetic activity
o Generalized arterial vasoconstriction
• ↑ HR and myocardial contractility
• ↑ MAP
35. What are the hormones are secreted during hemorrhage? Briefly state the rationale why these hormones are increased during times of stress.
1. Vasopressin (ADH): ↑ water reabsoprtion by the kidneys to = ↑ Plasma ADH=↑ Plasma Permeability Distal
increase blood pressure. It is actively secreted by Posterior tubules and Collecting ducts= ↑ H2O
Pituitary Gland in response to hemorrhage. The plasma Reabsorption
conc. of vasopressin rises progressively as arterial blood And less water is secreted
pressure diminishes. 2. Renin: secreted by the juxtaglomerular apparatus because of
Water deficit= ↑ Extracelular Osmolarity= ↑ ADH Secretion diminished renal blood flow during hemorrhagic hypotension.
Renin= ↑ Angiotensinogen ↑ Angiotensin I ↑
Angiotensin II by ACE
= ↑ bloop pressure
3. Aldosterone: from the adrenal cortex stimulates Na
reabsorption. The diminished blood flow raises levels of
Angiotensin II favoring the release of Aldosterone. Na is
actively reabsorbed, and water accompanies the Na
passively.
37. Assuming that the dog and human physiology are the same and that the dog has body weight of 65Kg, estimate the a) total body water, b)
extracellular water, c) intracellular water, d) blood volume, and e) plasma volume. Identify normal extracellular fluid (plasma) osmolality and
concentrations of Na+, K+, Cl-, HCO3-, proteins, creatinine, and urea, and contrast these values with those for intracellular fluids. Identify major
routes and normal ranges for water intake and loss.
PBS ⇒ ↓ GF
↓ π GC ⇒ ↓ systemic plasma protein concentration,
GF
π GC ⇒ systemic plasma protein concentration,
39. Compare the distribution of cardiac output during hemorrhage and exercise.
Cardiac output is defined as the amount of blood that is pumped into increased cardiac contractility associated with the generalized
the aorta each minute by the heart. It also represents the quantity of increase in sympathetic neural activity.
blood that flows to the peripheral circulation; the cardiac output
transports substances to and from the tissues.
In this chart, it is determined by stroke volume and heart rate.
Stroke volume is the volume of blood that is ejected with each beat
while heart rate is the number of contractions of the cardiac
ventricles per unit time.
During hemorrhage, cardiac output decreases because there is a decrease in stroke volume due to hypovolemia that happens during hemorrhage.
40. Summarize the results of the intervention with regards pupils size, HR, MAP and urine output. Discuss the physiologic basis for the results. What
are the compensatory mechanisms activated by hemorrhage?
Hemorrhage = volume contraction ↓ total blood volume ↓ venous return ↓ preload ↓ SV ↓ CO ↓ MAP
(↑ HR to compensate) ↑ RAA & ADH, ↓ ANP water retention to maintain MAP = predominantly sympathetic response
Compensatory Mechanisms:
Baroreceptor Reflex: ↑ Sympathetic Tone; Arteriolar Constriction; Intense Renal Vasoconstriction:
Chemoreceptor Reflex: ↑ Existent peripheral vasoconstriction evoked by baroreceptor reflex
Cerebral Ischemia: Activation of sympathoadrenal system
Reabsorption of Tissue Fluids: ↓ Hydrostatic pressure in the capillaries; Reabsorption of interstitial fluid into the vascular compartment
Endogenous Vasoconstrictors: Cathecolamines; Vasopressin; Renin
41. Describe the different feedback mechanisms involved in the maintenance of ECF volume and plasma osmolality?
• Plasma Osmolality - is a measure of the concentration of substances such as: Na+, K+, Cl-,urea, glucose, and other ions in the human blood
(normal: 285 – 295 mOsm/kg H2O)
42. Discuss the consequences in the different body water compartments if hypertonic and hypotonic solutions are infused intravenously.
Sixty percent of body weight consists of water, two-thirds of which is intracellular. Alterations in the concentration of salt, whether due to
primary changes in the amount of water or the amount of salt in the body can be of pathophysiologic importance. Note that sodium chloride is the
predominant solute in extracellular fluid (ECF). In contrast, cells contain mostly potassium, phosphate and proteins. This distribution of solutes
between cells and ECF is fundamental to the maintenance of normal cell function. Each solute has its own specific set of physiologic functions, yet
the total concentration of solute is also an important parameter.
The total amount of solute in a given amount of water is referred to as the osmolality of the solution. If two solutions of different osmolalities
are placed on different sides of a membrane that is permeable to solutes and water, water will move from the low to the high osmolality solution
while solutes will move in the opposite direction until both solutions have the same osmolality. Note that sodium, potassium, chloride and proteins
are not evenly distributed across the plasma membrane. This situation is more analogous to the experiment where two solutions of different
osmolalities are placed on different sides of a membrane that is permeable to water, but not to solutes. In this case, only water moves across the
membrane - which it continues to do until the osmolality is the same on both sides. The total amount of solute in a given amount of water that can
not cross a membrane freely is referred to as the tonicity of the solution. Now consider the cell: movement of most solutes across the plasma
membrane is restricted and water can move freely. Hence, it is the movement of water between intracellular fluid (ICF) and ECF that establishes
osmotic equilibrium across the plasma membrane.
The amount of intracellular solute is relatively constant under most conditions, however the amount of extracellular solute varies. This is so because
the major solutes that we ingest are sodium and chloride which are largely confined to the extracellular space. Hence, ECF and ICF tonicity and
volume are primarily dependent on the amounts of sodium and water in the body. This conclusion is illustrated by the following examples.
Suppose we give intravenous hypertonic sodium chloride (tonicity greater than that of the ECF):
(Osmolality = 1000 mOsm/kg)
ECF sodium concentration rises with hypertonic NaCl administration. Since sodium can not enter
cells, this draws water out of the intracellular space. Hence, hypertonic NaCl increases ECF volume
and sodium concentration/osmolality, while decreasing intracellular volume. And increase in water
movement in to the ECF.
At osmotic equilibrium
- Higher Osmolality for ECF and ICF than before infusion
- ↑Volume ECF
- ↓Volume ICF
Now suppose we give hypotonic NaCl (e.g. 1/2 normal saline or tonicity one-half that of normal ECF):
ECF sodium concentration falls lowers ECF tonicity causing water to move into cells water
will stop moving into cells when ECF tonicity = ICF tonicity.
Hence, hypotonic fluid administration:
(Osmolality = 145 mOsm/kg)
a) lowers ECF sodium concentration/osmolality
b) increases cell water content/ICF
c) increases ECF volume.
Note that the increase in ECF volume is less than that seen with normal saline because some of the administered water moved into the cells.
At Osmotic Equilibrium:
- Lower osmolality for ECF and ICF before infusion
- Greater Volume in increase in ECF than ICF
• Involved in the autoregulation of the GFR and RBF together with the Myogenic Mechanism
• Two parts of the mechanism:
o Afferent arteriolar mechanism
o Efferent arteriolar mechanism
(dependent of the juxtaglomerular complex)
• Juxtaglomerular complex consists of:
o Macula Densa Cells
• At the initial portion of the distal tubule
• Fx: senses the decrease of the NaCl concentration due to decrease in blood pressure. Effect:
• ↓ resistance of the afferent arterioles = ↑ GHP and GFR
(for it to become normal)
Glomerulotubular Balance
• The ability of the tubules to increase reabsorption rate in response to increased tubular load (increased tubular inflow)
• Ensures that the reabsorption rate of the proximal tubule is matched to the glomerular filtration rate.
• Helps to prevent overloading of distal tubular segments when GFR increases
• Refers to the fact that the total rate of reabsorption increases as the filtered load increases, even though the percentage of GFR
reabsorbed in the proximal tubule remains relatively constant at about 65 per cent
• it is independent of any hormones
• Two mechanisms:
(1)oncotic and hydrostatic pressures between the peritubular capillaries and the lateral intercellular space (i.e. Starling’s forces)
This protein-rich plasma leaves the glomerular capillaries, flows through the efferent arteriole, and enters the peritubular capillaries. The
increased oncotic pressure in the peritubular capillaries augments the movement of solute and fluid from the lateral intercellular space into the
peritubular capillaries. This action increases net solute and water reabsorption by the proximal tubule.
↑ protein = ↑ release of amino acids into the blood (reabsorbed in the proximal tubule)
Amino Acids and sodium are reabsorbed together. Therefore there is a decrease delivery of NaCl to the Macula Densa. This causes the increase
GFR and RBF due to decrease resistance of afferent arteriole. But there is still increase excretion of waste products.
Glucose is also reabsorb along with sodium. There is also decrease in the delivery of NaCl to the Macula Densa. Therefore there is
an increase in the GRF and RBF
44. Summarize the results of the intervention. Give the physiologic basis for the results.
Parameter Effect
Cardiac rate Increase
MAP Increase
Urine output Decrease
Increase solute concentration is being reabsorbed by the proximal collecting tubule. Therefore by diffusion increases water reabsorption would
follow resulting to a decrease in the urine output.
Antidiuretic Hormone
• Most important hormone that regulates water balance
• Synthesized in the supraoptic and paraventricular nuclei of the hypothalamus
• Secreted by the posterior pituitary
Antidiuretic Hormone
• Two classes of stimuli that cause ADH release:
o osmotic stimuli (osmoreceptors)
o pressure stimuli (baroreceptors)
Physiology of ADH release
ADH is synthesized in the supraoptic and paraventricular nuclei of the hypothalamus. ADH is stored in granules which travel down the pituitary stalk
to the posterior pituitary where they are released under the appropriate stimuli. There are two classes of stimuli that cause ADH release: osmotic and
pressure stimuli. An increase in osmolality activates osmoreceptors that increase ADH release, while a decrease in pressure in the arterial or
venous side of the circulation activates baroreceptors which stimulate ADH release
During volume expansion, the volume sensors send signals to the kidneys, resulting in an increase in the excretion of NaCl and water. The signals
acting on the kidneys include
Decreased activity of the renal sympathetic nerves.
Release of ANP from atrial myocytes as well as other natriuretic peptides (e.g., urodilatin in the kidney).
Inhibition of ADH secretion from the posterior pituitary.
Decreased renin secretion, and thus decreased production of angiotensin II.
Decreased secretion of aldosterone, due to reduced angiotensin II levels, and elevated ANP levels.
The integrated response of the nephron to these signals is illustrated in Fig. 36-7. The important difference between a situation during volume expansion
and that during the euvolemic state is that the renal response is not limited to the collecting duct; rather, it involves the entire nephron.Three general
responses to volume expansion occur (Fig. 36-7). The numbers correlate to those encircled in the figure.
GFR increases. GFR increases primarily as a result of the decrease in sympathetic nerve activity. Sympathetic fibers innervate the afferent and efferent
arterioles of the glomerulus and control their diameter. Decreased sympathetic nerve activity leads to their dilation. Because this effect appears to be
greater on the afferent arteriole, the hydrostatic pressure within the glomerular capillary is increased, and GFR increases. ANP and urodilatin also
increase GFR by dilating the afferent and constricting the efferent arterioles. With the increase in GFR, the filtered load of Na+ increases.
Reabsorption of Na+ decreases in the proximal tubule. Several mechanisms appear to be involved in reducing Na+ reabsorption by the proximal tubule,
but the precise role of each of these mechanisms remains controversial. Because activation of the sympathetic nerve fibers innervating this nephron
segment stimulates Na+ reabsorption, the decreased sympathetic nerve activity resulting from volume expansion may contribute to the decreased Na+
reabsorption that occurs. In addition, angiotensin II directly stimulates Na+ reabsorption by the proximal tubule. Because angiotensin II levels are also
reduced under this condition, it is possible that proximal tubule Na+ reabsorption is decreased as a result. The increased hydrostatic pressure within the
glomerular capillaries also leads to an increase in the hydrostatic pressure within the peritubular capillaries. This alteration in the capillary Starling forces
reduces the absorption of solute (e.g., NaCl) and water from the lateral intercellular space, thus reducing tubular reabsorption (see Chapter 35 for the
mechanism).
Na+ reabsorption decreases in the collecting duct. Both the increase in the filtered load and the decrease in proximal tubule NaCl reabsorption result in
the delivery of large amounts of NaCl to Henle's loop and the distal tubule. Because increased activity of both sympathetic nerves and aldosterone
stimulates NaCl reabsorption by Henle's loop, the reduced nerve activity and low aldosterone levels seen with volume expansion could in theory reduce
NaCl reabsorption by this nephron segment. However, because reabsorption by the thick ascending limb is load dependent, these effects are offset, and
the fraction of the filtered load of Na+ reabsorbed by Henle's loop is actually increased. Nevertheless, the amount of Na+ delivered to the beginning of
the collecting duct is increased compared with the euvolemic state (Fig. 36-8).
The amount of Na+ delivered to the beginning of the collecting duct varies in proportion to the degree of volume expansion. This increased load of Na+
overwhelms the reabsorptive capacity of the collecting duct, which is even further reduced by the actions of ANP and urodilatin and by the decrease in
the circulating levels of aldosterone. The final component in the response to volume expansion is the excretion of water. As Na+ excretion increases,
plasma osmolality begins to fall. This results in decreased secretion of ADH. ADH secretion is also decreased in response to the elevated levels of ANP.
In addition, ANP inhibits the action of ADH on the collecting duct. Together, these effects decrease water reabsorption by the collecting duct, thereby
increasing water excretion by the kidneys. Thus, the excretion of Na+ and water occurs in concert; euvolemia is restored, and body fluid osmolality
remains constant. As already noted, the time course of this response (hours to days) depends on the magnitude of the volume expansion. Thus, if the
degree of volume expansion is small, the mechanisms just described will restore euvolemia within 24 hours. However, with large degrees of volume
expansion, the response can take several days.
In summary, the nephron's response to volume expansion involves the integrated action of all its parts. The filtered load is increased, proximal tubule
reabsorption is reduced (GFR is increased, whereas proximal reabsorption is decreased; thus, G-T balance does not occur under this condition), and the
delivery of NaCl to the beginning of the collecting duct is increased. This increased delivery, along with inhibition of collecting duct reabsorption, results
in the excretion of a larger fraction of the filtered load of Na+, thus restoring euvolemia.
2% Glucose (45 Melody Chua 46-48 by Danilyne Bambico)
• Muscle
o There is an increase ability to reabsorb glucose
• Hormones
o Insulin • Major Actions:
• It is synthesized in the pancreas (mainly by the • For mobilization of Glucose
beta cell of the Islet of Langerhans) o Hepatic Glycogenolysis
• It consist of an alpha and a beta chain linked o Hepatic Gluconeogenesis
by disulfide bonds o Fatty Acid Oxidation
• It is involved in the reuptake and storage of o Ketogenesis
glucose • Inhibits:
• Major actions: o Glucogen Synthesis
• For fuel storage: o Muscle Glucose Uptake
o Glycogen synthesis o Cellular Uptake of Amino Acid, Potassium,
o Muscle glucose uptake Magnesium
o Cellular uptake of amino acid, o Protein Synthesis
potassium, magnesium
o Protein synthesis o Somatostatin
• Inhibits: • Inhibits both the insulin and glucagon
o Lipolysis • Major Actions:
o Ketogenesis • Inhibition of insulin and glucagon secretion
o Hepatic glycogenolysis • Decrease the motility of GIT
o Hepatic Gluconeogenesis • Deacrease GIT secretion, degestion and
o Glucose Release absorption
o Muscle proteolysis • Coordinated the nutrient input in the system
o Glucagon like peptides
o Glucagon • Stimulates insulin release by changing the beta cell
• Synthesized by the alpha cells in the Islets of response to increase in glucose
Langerhans • Decrease of glucagon
• It is stimulated by a decrease in the glucose • Slows gastric emptying
level of the blood • Lowers plasma glucose concentration
o Pancreastatin
• Inhibits insulin secretion
• Involved in autofeedback regulation
46. Define plasma glucose threshold and renal transport maximum for glucose.
• Plasma glucose threshold: The plasma concentration of glucose in which glucose will first appear in the urine. When the plasma glucose
concentration rises above 200 mg/dl, the filtered load of glucose increases to more than 250 mg/min, and a small amount of glucose appears in
the urine.
• Glucose: 100% filterable; reabsorbed in first half of proximal tubule via Na/glucose symport powered by Na gradient generated by Na,K ATPase
(Na-linked secondary active transport)
• Renal transport maximum: maximum rate at which glucose can be transported from the tubules. At around 375 mg/min, all nephrons have
reached their maximum capacity to reabsorb glucose. After this point, glucose cannot traverse across the membrane, and will begin to appear
in urine.
• Definition: maximum rate of reabsorption (or secretion) of a substance
• tubular maximum rate (Tm) for glucose approx. 320 mg/min (may vary between diff. nephrons)
• Filtered load (mg/min) = plasma conc.(mg/ml) X GFR (ml/min)
• If filtered glucose load > Tm for glucose, then excess spills over into urine.
• Plasma glucose threshold = blood glucose conc. at which filtered glucose load starts to exceed Tm for glucose, resulting in glucosuria; Normal
value: 9 - 10 mmol/L (162 - 200 mg/dl).
47. In a normal individual, does glucosuria occurs during an oral glucose tolerance test (OGTT)?
The glucose levels of a normal, fasting person ranges from 50-110 mg/dl. The cells are deprived of glucose. Ingestion of glucose will stimulate
insulin to promote uptake of glucose into the cells. Almost all the glucose filtered by the glomerulus will be reabsorbed in the proximal
convoluted tubule by secondary active transport (cotransported with energy from Na+K+ ATPase). The renal threshold is 160 to 180 mg/dl. In
cases of hyperglycemia, reabsorption of glucose stops, thus glucose ix excreted. Glucosuria is seen in patients with diabetes mellitus, in which
there is a lack of insulin or there is insulin resistance. The fasting blood glucose levels for diabetic patients are almost always above 110 mg/dl.
On glucose ingestion, the blood glucose level is much greater than that in normal fasting patients, and glucose level falls back to control level
after 4-6 hours. Saturation of receptors in the kidneys occurs since there are above normal levels of glucose in the kidneys. This occurs at levels
above 11 mmol/L.
When a normal, fasting person ingests 1 gram of glucose per kilogram of body weight, the blood glucose level rises from 90mg/100 ml to 120-
140 mg/100ml, then falls back to below normal within 2 hours. He will not experience glucosuria as the amount of glucose ingested will not
cause the blood glucose level to exceed threshold.
• OGTT
• primarily measures the body's ability to use or metabolize glucose, involves ingestion of set amt. (75-100g) of glucose and measurement of
blood glucose level at set intervals, then compared with the pre-ingestion fasting blood glucose level.
• A normal individual will not experience glucosuria as the amount of glucose ingested is not enough to cause the blood glucose level to
exceed the threshold.
48. Summarize the results of the intervention. Give the physiologic basis for the results.
• Infusion ↑ ECF/ICF volume ↓ sympathetic ↑ ANP, ↓ ADH & RAA ↑ Na, H20 excretion ↑ urine output
• Initially the 2% glucose is isotonic to ECF; when ingested, the glucose is quickly metabolized and the solution becomes hypotonic. ECF volume
increases, ECF osmolality decreases. Water moves into the cell, also increasing ICF volume. Osmolality decreases. Volume expansion leads to
decreased sympathetic activity, stimulating atrial natriuretic peptide while inhibiting vasopressin and the renin-angiotensin-aldosterone. Sodium
and water excretion is promoted due to decreased RAA activity, resulting in diluted urine.
49. Identify the normal range of pH values, and the upper and lower limits compatible with life. Describe the role of buffers in maintaining pH,
including the roles of the lungs and kidneys.
• Recall: Acidosis (acidaemia) is defined as a disorder with pH in the arterial blood (pHa) less than 7.35, and alkalosis (alkalaemia or baseosis) is
defined as a condition with a pHa larger than 7.45.
• People can suffer from 4 different acid-base disorders: Respiratory alkalosis and acidosis, and metabolic alkalosis and acidosis. Each
is compensated for by the body by complementary actions. That is, if the alkalosis or acidosis is respiratory in nature, then the body’s
response is likewise respiratory. And vice versa.
• Thus, the kidneys serve to compensate for metabolic acid-base imbalances
• While the lungs are responsible for respiratory acid-base imbalances
50. Distinguish between the reclamation of filtered bicarbonate and the formation of new bicarbonate.
Since both are bicarbonate (basic) saving, then we can assume that both actions are a means of increasing pH, and therefore occur in order to
balance a patient experiencing:
Metabolic Acidosis
The obvious distinction here is that the former attempts to recycle bicarbonate which has been filtered, while the latter is the generation of new
bicarbonate in the distal tubule; both however work to replenish body buffer stores and function as compensatory (metabolic as opposed to
respiratory) alkalosis.
Reabsorption of bicarbonate in the proximal and distal parts of the each bicarbonate produced in the cell from the CO2 of the tubular fluid,
nephron. one bicarbonate ion diffuses to the interstitial phase and the renal venous
Also within the cell CA facilitates the production of (H+ + HCO3-). For blood back to the body (Fig. 17-4). The cells of the thick ascending limb of
the Henle loop also reabsorb bicarbonate by the same mechanism as
in the proximal tubule
The small residue of bicarbonate enters the distal tubules, where it is
reabsorbed almost totally through a special mechanism independent
of Na+ . In the intercalated cells of the collecting ducts, the
reabsorption is dependent on a proton-K+-ATPase (Fig. 17-4). The
bicarbonate ion crosses the basolateral cell membrane in exchange of
chloride through a chloride-bicarbonate antiporter. - This special
mechanism is most likely ineffective in distal renal tubular acidosis.
Acidosis, which involves the intracellular space and stimulates
production of proton-K+-ATP-ases, also favours H+ -secretion. Hereby,
bicarbonate reabsorption is stimulated, whereas alkalosis inhibits
bicarbonate reabsorption by the opposite mechanisms.
Aldosterone stimulates the proton-K+-ATPases of the intercalated
cells and the Na+-reabsorption/ K+ -secretion of the principal cells.
Both effects favour H+ -secretion and thus bicarbonate reabsorption.
51. Describe net acid excretion by the kidneys, titratable acid, the importance of urinary buffers, and the production and excretion of ammonium.
What do you think will happen to the titratable acid, the importance of urinary buffers, and the production and excretion of ammonium during lactic
acid infusion.
Glutamate metabolism and renal ammonia production. The renal handling of ammonia and the excretion by diffusion trapping is shown.In
the proximal tubules of the kidneys, renal glutamate produces NH4+ and a-ketoglutarate. One molecule of NH4+ is produced by deamination of one
glutamine molecule by the enzyme, glutaminase, and a second by oxidative deamination of glutamic acid forming a -ketoglutarate that is
metabolised. The NH4+ in the proximal tubule cells is in equilibrium with minimal amounts of NH3 at the relatively low pH. The NH4+-secretion into the
tubular fluid makes use of the Na+-H+-antiporter, where NH4+ substitutes H+. The NH4+ passes with the tubular fluid to the thick ascending limb of the
Henle loop, where a major portion is reabsorbed and accumulated in the interstitial fluid (Fig. 17-5).
Secretion of NH4+ in the collecting ducts involves a special mechanism. The NH3 is lipid soluble and easily passes any membrane, so it reaches the
tubular fluid of the collecting ducts and form NH4+ at the low pH (Fig. 17-5). The charged molecule cannot pass the membrane and it is trapped in
the tubular fluid and eliminated in the urine. This diffusion trapping of charged molecules such as NH4+ is called non ionic diffusion - a general
elimination principle for many charged metabolites and drugs. Excretion of NH4+ reduces the excretion of other positive ions.
The a -ketoglutarate is metabolised into bicarbonate. Bicarbonate of the extracellular fluid reacts with H+ from hepatic phosphoric and sulphuric acid
to form carbon dioxide and water. The H2PO4- (and a minimal amount of SO42-) is excreted in the urine. On a mixed diet the production and excretion
of non-volatile acids and bases results in a net excretion of acids equal to the daily net production of non-volatile acids.
With a urine pH of 6.5, organic acids such as lactic acid, b-hydroxybutyric acid, pyruvic acid etc., are present in the base form (RCOO- of Fig. 17-6).
Most of the phosphoric acid is H2PO4-, and almost all ammonia is in the NH4+ form.
Excretion flux for organic bases (RCOO-), titratable acid (H2PO4-), and NH4+ in normal daily urine.
This is not so in an alkaline urine. At a urinary pH of 8, there is 5% NH3 of the total, just as in ileum and colon, where the pH is also 8.
The high pK (=9.3) of NH3/NH4+ has the consequence that in gastric juice with a pH of 1, the (pH-pK)- difference is -8.3, so virtually all ammonia must
be NH4+. Even in body fluids with a pH of 7.3 the NH3/NH4+ ratio is 1/100.
Lactic acidosis a result of lactic acid infusion can be caused by increased lactic acid production during exercise, shock, anoxia or following cardiac
arrest. Another type of lactic acidosis is caused by decreased hepatic lactate metabolism - often drug-induced.
The body therefore compensates for this acidosis through the aforementioned compensatory behaviors.
52. Summarize the results of the intervention. Give the physiologic basis for the results
Parameter Effect Explanation
Pupil size ↑ Sympathetic stimulation of the alpha receptors of readial muscle lead to mydriasis (increase pupil size)
Cardiac rate ↑ ↑H+(↓pH) stimulation of ventilatory center, ↑RR CO2, ↓ pH
MAP ↑ Same as cardiac rate
Respiratory rate ↑ Same as cardiac rate
Intrapleural pressure ↑ Stimulation of resp. center diaphragm leads increased effort of breathing & increased intrapleural
pressure.
Intestinal movement ↓ Duet to sympathetic stilmuatlon and shunting of blood away from splancnic circulation, there’s
decreased peristalsis and muscle tone.
Urine output ↓ Increased sympathetic activity constricts vessels, increased MAP decreased renal blood flow and
decreased urine output.
Partial Airway Occlusion (53 by Bianca Arambulo 54-55 by Antoinette dela Pena 57-58 by Nicole Cacino 56, 59-60 by Pasky Atanga)
53. Diagram & discuss the lung volume, tracheal pressure, alveolar pressure, and pleural pressure during a normal quiet breathing cycle. Identify
the different phases of the respiratory cycle. Relate the pleural and airway pressure values to the movement of air.
54. State the relationship of the lung volume with the compliance/ elastance of the following a) lungs, b) chest wall and c) respiratory system.
Compliance - the extent to which the lungs expand for every unit
increase in transpulmonary pressure
Elastance - is the ability of the lungs or chest wall to return to its
resting state after distension; counteracts the force that tends to
distend or expand the lungs
Two components:
a. lung tissue itself
- collagen and elastin
b. surface tension
- fluid lining the alveolar walls
- ~2/3 of the total elastic forces
lung volume low ↑ high
compliance high ↓ Low
elastance low ↑ high
55. Discuss the factors that determine airway resistance. Discuss the factors that govern the luminal radius of an airway.
Airway resistance is the opposition to flow caused by the forces of friction. It is defined as the ratio of driving pressure to the rate of air flow.
Resistance to flow in the airways depends on whether the flow is laminar or turbulent, on the dimensions of the airway, and on the viscosity of the
gas.
For laminar flow, resistance is quite low. That is, a relatively small driving pressure is needed to produce a certain flow rate. Resistance during
laminar flow may be calculated via a rearrangement of Poiseuille's Law :
The most important variable here is the radius, which, by virtue of its elevation to the fourth power, has a tremendous impact on the resistance.
Thus, if the diameter of a tube is doubled, resistance will drop by a factor of sixteen.
For turbulent flow, resistance is relatively large. That is, compared with laminar flow, a much larger driving pressure would be required to produce
the same flow rate. Because the pressure-flow relationship ceases to be linear during turbulent flow, no neat equation exists to compute its
resistance.
While a single small airway provides more resistance than a single large airway, resistance to air flow depends on the number of parallel pathways
present. For this reason, the large and particularly the medium-sized airways actually provide greater resistance to flow than do the more numerous
small airways.
Airway resistance decreases as lung volume increases because the airways distend as the lungs inflate, and wider airways have lower resistance.
Tone of smooth muscle that surrounds airways affects their diameter and therefore resistance. Smooth muscle reacts to both parasympathetic and
sympathetic nervous activity. Stimulation of parasympathetic fibers releases Ach which causes smooth muscle contraction (thus constricting airways)
while sympathetic activation releases NE which relaxes smooth muscle causing dilation of the airway. Epinephrine and beta 2 agonists are powerful
bronchodilators. In addition, there are a large number of enteroendocrine cells in respiratory system whose secretions alter airway diameter.
Substance P is potent bronchoconstrictor and stimulator of mucus secretion. VIP has the opposite effect
56. Compare the excitation contraction coupling of the skeletal and bronchial smooth muscles. Discuss the consequences of the neostigmine
administration on the bronchial smooth muscle tone. Explain the changes seen in the intrapleural pressure and respiratory rate during neostigmine
administration.
Discuss the consequences of the neostigmine administration on the bronchial smooth muscle tone
Parameters Effect
AcetylCholinesterase activity Decreased
Acetylcholine Increased
Bronchial Smooth Muscle Contraction Increased
Surface Area Decreased
Respiratory Rate Increased
Intrapulmonary Pressure Decreased
Explain the changes seen in the intrapleural pressure and espiratory rate during neostigmine administration.
Intrapulmonary Pressure:
Neostigmine administration Parasympathetic stimulation Formation of IP3 and DAG, increased intracellular calcium bronchoconstriction
Decrease airway caliber INCREASED AIRWAY RESISTANCE DECREASED INTRAPLEURAL PRESSURE
Respiratory Rate:
Neostigmine administration Parasympathetic stimulation bronchoconstriction
INCREASED AIRWAY RESISTANCE LOW VENTILATION, LOW VQ (hypoxemia, hypercapnia) Peripheral and central chemoreceptor RESPIRATORY
RATE INCREASES
57. Give the effect of the changes in airway resistance and respiratory system compliance with the ventilation of the respiratory units.
• Compliance, ventilation
58. Discuss the pressure volume loop during tidal breathing and relate the components of work of breathing. Speculate on what will be the
pressure volume of the dog once the airway was partially occluded.
59. Describe pattern of airflow from the trachea to the alveoli. Relate the pattern of airflow to the Reynolds’s number.
Mechanisms of compensation
1.Immediate (even during first breath in which resistance is applied)
- muscle spindle inspiratory muscles fail to shorten
- DRG
2. Develops about 90 seconds & overacts for a similar period when the resistance is removed
- elevation of arterial PCO2
- Chemoreceptors
Hypoxemia Peripheral chemoreceptors CPG increase ventilation
Hypercapnia central chemoreceptors via change in CSF pH & peripheral chemoreceptors CPG increase ventilation
Carbogen (61 by Mary Grace Causapin 62 by Irish Chang 63-64 by Maylyn Cauilan 65-66 by Mary Grace Causapin)
61. Define partial pressure and fractional concentration as they apply to gases in air, airways, alveoli, pulmonary capillary blood, arterial blood and
venous blood. List normal values for each for O2, CO2, and N2. What happens to these values at high altitude and deep sea?
Partial pressure - The pressure that one component of a mixture of gases would exert if it were alone in a container
Gas Atmospheric gas composition partial Total pressure at sea level
pressure (%) ATM pressure = 760 mm Hg
Nitrogen 78.62 597.5
Oxygen 20.84 158.4
Carbon Dioxide 0.04 0.3
62. Define percent hemoglobin saturation, oxygen tension, oxygen content as they pertain to blood.
• Percent Hemoglobin saturation
o The chemical binding of O2 to hemoglobin occurs in the lung and this HgbO2 complex is the major transport mechanism for
oxygen
o number of O2 molecules bound to hemoglobin is dependent on the partial pressure of O2 in the blood. the partial pressure of O2
rises, hemoglobin saturation increases.
o OXYGEN HEMOGLOBIN DISSOCIATION CURVE: At partial pressures below 60 mm Hg, oxygen readily binds to
hemoglobin as the PO2 increases. At a PO2 of 60 mm Hg, hemoglobin is 90% saturated; increases in PO2 above this level will
influence hemoglobin saturation only slightly. Specifically, increasing the PO2 from 60 to 100 mm Hg will increase the
hemoglobin saturation by only 7%. The clinical significance of the flat portion of the oxy hemoglobin dissociation curve is that a
drop in PO2 from about 100 mm Hg to about 60 mm Hg still results in a hemoglobin saturation of more than 90%, which virtually
ensures adequate O2 transport. Also, increasing the PO2 above 100 mm Hg has little effect on the oxygen content in the blood,
because hemoglobin is already fully saturated. In the steep portion of the curve, blood oxygen content and thus oxygen delivery
to the tissue are significantly compromised when the PO2 falls below 60 mm Hg. The clinical significance of this portion of the
curve is that a large amount of O2 is released from hemoglobin with only a small change in PO2. This response facilitates the
diffusion of O2 to the tissue. The point on the curve at which 50% of the hemoglobin is saturated with O2 (two oxygen molecules
on one Hgb molecule) is called the P50
o RISE in 2-3HCOT will make Hgb REJECT O2 leading to REDUCED Hgb saturation. This will casue a RIGHT shift of the Hbg-
O2 dissociation curve and will manifes as a RISE in P50; LOW levels of 2-3 HCOT will make Hgb LOVE O2 thus resulting in
higher Hgb-O2 saturation, causing a shift to the LEFT of the Hgb-O2 dissociation curve manifested by a LOWER P50.
• Oxygen tension (PO2)
o The composition of a gas mixture can be described in terms of either the gas fractions or the corresponding partial pressure.
o When Boyle's gas law is applied, the sum of the partial pressures (in mm Hg) or of the tensions (in torr) of a gas must be equal to
the total pressure. Thus, at sea level, where the partial pressure is 760 mm Hg, the partial pressures of the gases in the
atmospheric air [also known as the barometric partial pressure (Pb)] are
The second important principle is that the partial pressure of a gas (Pgas) is equal to the fraction of gas in the gas mixture (Fgas)
times the total or ambient (barometric) pressure.
Ambient air is composed of approximately 21% oxygen and 79% nitrogen. Therefore, the partial pressure of oxygen in ambient
air (PO2) is
o When there is both normal alveolar ventilation and normal alveolar capillary blood flow (normal alveolar perfusion), exchange of
oxygen and carbon dioxide through the respiratory membrane is nearly optimal, and alveolar Po2 is normally at a level of 104
mm Hg, which lies between that of the inspired air (149 mm Hg) and that of venous blood (40 mm Hg). Likewise, alveolar Pco2
lies between two extremes; it is normally 40 mm Hg, in contrast to 45 mm Hg in venous blood and 0 mm Hg in inspired air.
Thus, under normal conditions, the alveolar air Po2 averages 104 mm Hg and the Pco2 averages 40 mm Hg.
o
• Oxygen content (in mL)
o Amount of oxygen carried by blood in mL
o Not synonymous to O2 tension
o (O2 in physical solution) + (bound to Hgb)
Physical solution = 0.003ml/dl x PaO2
Bound to hemoglobin = (Hgb grams /dl) x (1.34 ml/gram) x (O2 sat)
o Determinants
Directly proportional to minute ventilation, alveolar ventilation and hemoglobin level
Inversely proporitional to dead space ventilation
Position of O2 dissociation curve
63. List the normal alveolar, arterial, and mixed venous blood gas values for Po2, Sato2, Pco2, HCO3, and pH.
Alveolar Arterial Venous
PO2 104 mm Hg 95 mm Hg 40 mm Hg
SatO2 98% 97.5% 75%
PCO2 40 mm Hg 40 mm Hg 45 mm Hg
HCO3 24 mEq/L 24 mEq/L 21.9 mEq/L
pH 7.40 7.40 7.31
64. Discuss the hemoglobin oxygen dissociation curve. Enumerate the conditions that may alter its normal position. Name the five causes of
hypoxemia. Identify the factors that determine O2 delivery.
Causes of Hypoxemia
1. Shunt – inc. P(A-a)O2 PaCO2 normal
- cannot be corrected with supplemental oxygen
Determinants of O2 delivery
Chemoreceptors
•central and peripheral chemoreceptors. ↓ Inspired PO2
•They respond to changes in the PCO2, pH, and PO2 of arterial blood.
↓ Alveolar PO2
Central Chemoreceptors in the medulla monitor the pH associated with CO2
levels within the cerebrospinal fluid in the fourth ventricle
↓ Arterial PO2
Chemoreceptors
•The Peripheral Chemoreceptors are found in two locations:
1. the aortic bodies within the aortic arch
Peripheral Chemoreceptors
2. the carotid bodies at the bifurcation of the common carotid arteries
↑ Firing
•They are stimulated by Reflex via the medullary
–Decreased PO2 (hypoxia) respiratory neurons
–Increased hydrogen ion concentration (metabolic acidosis)
–Increased PCO2 (respiratory acidosis) Respiratory Muscles
↑ Contractions
↑ Alveolar PCO2
↑ Arterial PCO2
Peripheral chemoreceptors
Peripheral Chemoreceptors: Effect of PO2
↑Firing Central chemoreceptors
• The peripheral chemoreceptors also respond to acids such as lactic
↑ Firing
acid, which is produced during strenuous exercise:
• Active muscles produce lactic acid, which enters the blood,
releases hydrogen ions, and lowers the pH. Respiratory Muscle
• The decreased pH stimulates the peripheral chemoreceptors to ↑ Contraction
send more nerve impulses to the respiratory centers, which stimulate
the respiratory muscles to increase the breathing rate and depth.
• More carbon dioxide is exhaled, lowering the PCO2 in blood, driving ↑ Ventilation
the chemical reaction to the left, and lowering hydrogen ion levels.
• The peripheral chemoreceptors also monitor arterial PO2, however,
the arterial PO2 must drop below 60 millimeters of mercury before Return of alveolar and arterial PCO2 to normal
the chemoreceptors respond.
• The normal alveolar PO2 of about 100 millimeters of mercury
results in 98% hemoglobin saturation in the blood.
• If the PO2 drops to 60 millimeters of mercury, hemoglobin is still
Return of brain ECF PCO2 to normal
90% saturated. Return of alveolar and
• Any increased ventilation in this range of PO2's results in only a arterial [H+] to normal
small increase in the amount of oxygen loaded into the blood.
• However, at very high altitudes, the alveolar PO2 may fall to 40 Return of brain ECF [H+] to normal
millimeters of mercury and hemoglobin will be only 75% saturated. At
this point, increased ventilation will make a dramatic difference in
66. Summarize the results of the intervention. Give the physiologic basis for the results.
Carbogen
has higher than normal levels of carbon dioxide. When taken intentionally to trigger an abreaction it can also cause feelings of panic and anxiety.
Carbogen is inhaled, the increase of carbon dioxide in the lungs causes a perception of physiological hyperventilation.
hyperventilation (or overbreathing) is the state of breathing faster and/or deeper than necessary, thereby reducing the carbon dioxide concentration
of the blood below normal.
Introduction of carbogen will be detected as increase in PCO2 and Decrease in PO2 by the chemoreceptors that will stimulate the vasomotor region
in the medulla. It elicits a constellation of sympathetic response.
Pupil Size
Vasomotor center (medulla)=>Sympathetic Discharge =>Stimulate the
α adrenergic receptors of the iris (radial muscle) -->Dilation of pupil
Cardiac rate:
↑ Increase in CO2 and H+ Stimulate central chemoreceptors --> ↑
sympathetic stimulation
--> ↑ contraction of cardiac muscles --> ↑ heart rate and force of
atrial and ventricular contractions --> ↑ in Cardiac output
Respiratory rate
↑ in CO2 and H+ --> Stimulate central chemoreceptors --> Muscles
of inhalation and exhalation to contract more forcefully and more
frequently (hyperventilate) --> ↑ in Respiratory rate
Intrapleural pressure
↑ CO2 and H+ --> ↑ ventilatory drive --> ↑ tidal volume --> ↑
intrapleural pressure
Intestinal movement
↑ in CO2 and H+ Stimulate contraction of of sphincter --> ↓ in
motility and tone --> ↓ intestinal movement
Urine output
↑ in CO2 and H+ --> Stimulate the constriction of the blood vessels
(kidney arterioles) --> ↓ GFR and inhibition to the detrussor muscle
--> ↓urine volume
Carbogen intervention (5% CO2- 95% O2 mixture gas tank) = High CO2 and high O2
Effects: ↑ CO2 = ↑ H+ in blood = ↑ sympathetic / ↓ parasympathetic
Parameter Effect Explanation
Pupil size Sympathetic dominance (α adrenergic)
Cardiac rate Sympathetic dominance
MAP ↑ HR x SV = CO x TPR = MAP, so ↑ HR ↑ MAP
Respiratory rate Central chemoreceptor stimulation (via CO2 and H+) ↑ ventilation
Intrapleural pressure Central chemoreceptor stimulation (via CO2 and H+) ↑ ventilation ↑ TV
Intestinal movement ↓
Sympathetic dominance
Urine output
67. Discuss the different lung volumes and capacity. What will be the effect of pnuemothorax on these volumes and capacities.
• Tidal volume (TV) = volume of air entering or leaving the lungs during a single breath.
• Inspiratory reserve volume (IRV) = volume of air which can be inspired over and above the resting tidal volume
• Expiratory reserve volume (ERV) = volume of air which can be expired after a normal expiration.
• Residual volume (RV) = volume of air remaining in lungs after maximal expiration, can be estimated as 25% of the vital capacity
• Inspiratory capacity (IC) = maximum volume which can be inspired after a normal expiration = IRV + TV
• Vital capacity (VC) = maximum volume that can be expired after a maximal inspiration = IRV + TV + ERV
• Functional residual capacity (FRC) = volume of air left in the lungs after a normal expiration = ERV + RV
• Total lung capacity (TLC) = volume of the lungs when fully inflated = VC + RV (or 1.25 x VC)
• Pneumothorax – air in pleural space lung volumes are not equal, lung collapse = ↓ volumes & capacities BUT RV is maintained; low FVC,
normal or low FEV1, FEV1/FVC > .75
68. Review the different types of VQ relationships and its corresponding O2 & CO2 tensions.
V/Q (Ventilation-Perfusion) = O2 delivery to alveoli & CO2 elimination from alveoli / O2 elimination from alveoli & CO2 delivery to alveoli
Types VQ O2 CO2
Infinity ∞ ↑ ↓ Lung Zone V/Q PAO2 PCO2
High >1 ↑ ↓ Upper High ↑ ↓
Ideal 1 104 40 Middle Almost ideal 104 40
Low <1 ↓ ↑ Lower (V/Q is 3x/8x) Low ↓ ↑
Zero 0 ↓ ↑
VQ= 0
The air in the alveolus comes to equilibrium with the blood oxygen and carbon dioxide because these gases diffuse between the blood and
the alveolar air. Because the blood that perfuses the capillaries is venous blood returning to the lungs from the systemic circulation, it is the
gases in this blood with which the alveolar gases equilibrate. In Chapter 40, we will learn that the normal venous blood ([vbar]) has a Po2
of 40 mm Hg and a Pco2 of 45 mm Hg. Therefore, these are also the normal partial pressures of these two gases in alveoli that have blood
flow but no ventilation.
VQ = infinity
The alveolar air becomes equal to the humidified inspired air. That is, the air that is inspired loses no oxygen to the blood and gains no
carbon dioxide from the blood. And because normal inspired and humidified air has a Po2 of 149 mm Hg and a Pco2 of 0 mm Hg, these
will be the partial pressures of these two gases in the alveoli.
69. Identify the average V/Q ratio in a normal lung. Explain how V/Q is affected by the vertical distribution of ventilation and perfusion in the
lung.
*Lower lung zones are better ventilated (3x) & better perfused (8x)
[Gravity affects transpulmonary & intrapleural pressure making it less (-)]
70. Summarize the results of the intervention. Give the physiologic basis for the
results. Speculate on the VQ relationship on the normal and abnormal lung. What are the consequences on the O2 tension, hemoglobin O2
saturation and O2 delivery to the tissues?
Pneumothorax Lung collapse ↓ Lung volume ↓ ventilation (dec. lung compliance) ↓ PAO2 (bec. Of dec. ventilation) ↓ Hgb-O2 sat
(Hgb rejects O2) ↓ O2 delivery to tissues (Hgb fails to deliver O2) ↑ PCO2 (bec. of dec. O2) ↑ H+ (bec. of inc. CO2) peripheral
chemoreceptors (bec. of ↑ CO2 & ↑ H+) ↑ RR (caused by chemoreceptors) ↑ intrapleural pressure (caused by ↑ RR) *making it more (-)
sympathetic responses (↑ cardiac rate, ↑ MAP, ↑ renin-angiotensin release leading to ↑ water retention or ↓ urine output
71. Enumerate the origin of the different sensory fibers conducted by the vagus nerve.
The Vagus nerve is a mixed cranial nerve that is distributed from the head and neck into the thorax and abdomen. Its sensory axons arise
from the skin of the external ear, a few taste buds, baroreceptors and chemoreceptors in the carotid sinus and carotid body, and visceral
sensory receptors in most organs (thoracic and abdominal). It is composed of parasympathetic fibers and supplies 75% of parasympathetic
action to the body.
• Nucleus ambiguous- motor nucleus of the vagus nerve (modifies activity of cardiac muscle)
• Dorsal Nucleus of the Vagus – largely secretomotor (activates glands) in the thoracic and abdominal cavity
• Nucleus of the tract of solitarius – sensory fibers from the pharynx, larynx, and esophagus
72. Summarize the results of the intervention. Give the physiologic basis for the results based on your answer to the previous guide question.
As discussed in previous labcons, a central stump can create a sympathetic effect to the body thus increasing the results except for
intestinal movement and urine output which it decreases. Physiologic basis of the sympathetic response was already discussed in the
stimulation of the sciatic nerve. After stimulation of the vagus central stump, parasympathetic fibers and effect will predominate.
Parasympathetic nervous system uses acetylcholine as its primary neurotransmitter therefore it has cholinergic receptors. Cholinergic
receptors are divided into nicotinic and muscarinic receptors. Nicotinic responses are of fast onset, short duration and excitatory in
nature. Muscarinic responses are diverse, slower, and longer-lived inhibitory.
Muscarinic receptors
M1 receptors: producing slow excitation of ganglia
M2 receptors: causing decrease in cardiac rate and force of contraction
M3 receptors: causing secretion and contraction of visceral smooth muscle
When ACh binds to a muscarinic receptor, it causes K+ ions to leave the muscle, hyperpolarizing the membrane &causing an IPSP. It
decreases action potential of the tissue therefore causing it to counteract the effect of the sympathetic nervous system.
Muscarinic receptors are G- protein coupled receptors which causes activation of phospholipase C (formation of IP3
and DAG as 2nd messenger), inhibition of adenyl cyclase, and activation of K channels or inhibition of Ca channels
It can also be caused by the baroreceptor reflex. When the afferent fibers of the vagus sensed, for example, the increased cardiac rate, it
activates the solitary nucleus which then activates the dorsal nucleus and nucleus ambiguus of the vagus nerve. These nuclei would
activate preganglionic and postganglionic receptors to cause the decrease in heart rate.