Paramedic Care: Principles & Practice
Volume 1 Introduction to Advanced Prehospital Care
Chapter 8 General Principles of Physiology and Pathophysiology
Chapter 8, Part 1 The Cell and the Cellular Environment
Part 1 Topics
The Normal Cell How Cells Respond to Change and Injury The Cellular Environment: Fluids and Electrolytes Acid-Base Balance
All Living Things Are Composed of Cells Cells Are the Functional Unit of the Body Continuity of Life: Cells come from other cells
Human Body contains 50-106 trillion cells 200 different cell types Range from 2 micrometers to 1 meter in length
The Normal Cell
Three main elements:
Cell membrane Cytoplasm Organelles
.The Normal Cell
The cell is the fundamental unit of the human body.
The membrane is selectively permeable
Cytoplasm viscous fluid that fills and gives shape to the cell
Electrolytes. proteins. and lipids
Structures that perform specific functions within the cell
. glucose (sugar).Cellular Components
Membrane encircles and protects the cell.
The Cell Membrane
Nucleus Endoplasmic reticulum Golgi apparatus Mitochondria Lysosomes Peroxisomes
many nuclei Anucleate . the nuclear envelope Contains genetic information (DNA) in the form of genes Nucleolus .NUCLEUS
Cell control center.directs activities Bounded by a double membrane.site of ribosome assembly Multinucleate .no nucleus
chemical substances that may be stored in the cytoplasm
Cell forming material
viscous transparent fluid organelles .“little organs” Inclusions .
sort and modify proteins and lipids for export or cell use
.series of flattened membrane sacs that process.transport & membrane synthesis smooth ER .synthesize proteins Golgi apparatus .lipid synthesis & drug detoxification
rough ER .
transport substances across the membrane Flagella . short.form part of the cytoskeleton that serve as support structures and assist with cell movement
Mitochondria . used to propel the cell
. digest bacteria Microtubules / Microfilaments .ATP formation Lysosome .often single.contain hydrolytic enzymes that break down molecules.
contain enzymes that oxidize toxic substances (neutralize free radicals) Centrosomes/centrioles .ORGANELLES
Peroxisomes . melanin
.function in cell division Storage organelles . Vesicles. may contain:
Size does matter!
Cells range from 1–200 m Lower limit (0. Upper limit determined by need to transport materials across surface
Large cells have lower surface to volume ratio
.2 m) determined by space needed for ribosomes. DNA.
internal membranes rare DNA localized in nucleoid region. NO NUCLEUS growth due to increase in numbers rather than size high surface to volume ratio
.Prokaryotic Cell Structure
bacteria & archaea
very small 0.5 µm no organelles.5 .
Internal membranes form different compartments to carry out specific activities
Energy metabolism Protein processing Recycling Information storage
forming an ionic bond. A charged atom or group of atoms is called an ion.Ions/Ionic bonds
Some atoms can donate or accept electrons
# of protons (+ charge) and electrons (.charge) become imbalanced.
. Oppositely charged atoms are attracted to each other. Atom acquires a net charge.
Some atoms share electrons – forming covalent bonds Shared electrons spend time orbiting both atoms Important elements
C – 4 bonds N – 3 bonds O. S – 2 bonds H – 1 bond
Polar Covalent Bonds
Some atoms such as O. N attract electrons strongly Unequal sharing of electrons creates partial charges at ends (poles) of covalent bond Opposite partial charges on the same or separate molecules are attracted to each other – forming hydrogen bonds (H-bonds)
Surface tension adhesion. Water molecules stick to each other and to other things.Why is water special?
Water is a polar molecule. capillary action and redwood trees collapsed lungs surfactants cohesion
. Two ends of molecule have opposite charges.
polar molecules do not interact with water.
.Water as a solvent
Water can interact with other polar substances. therefore they dissolve well Charged on ions are stabilized by partial charges in water Non.
Substances that do not interact with water referred to as hydrophobic hydrophobic molecules are aggregated to minimize disruption of water’s H-bonding network.
Nature builds “big” things by organizing and connecting “little” things.
Societies Families individuals/organisms organs tissues cells molecules
The whole is greater than the sum of its parts.
. fructose Monosaccharide = 1 sugar
.g.pentoses (n=5) – Ribose. e. hexoses – (n=6) .Hydrated Carbon
Carbohydrates have a base formula of (CH2O)n names end with “ose”.glucose. ribulose.
.Water used to split a molecule Can be continued ad infinitum .The most important chemical reactions in living organisms
Condensation . Hydrolysis .Removal of H and OH from two separate molecules forms water and connects the two molecules.
2 monosaccharides can be linked to form a disaccharide Oligosaccharides contain several different sugars linked in different types of linkages.
Present on cell surface proteins and lipids.
starch (plants) and cellulose (plants). Glucose is used to produce glycogen (animals).
Sugars (monosaccharides) can be connected to form polysaccharides – usually only 1 or 2 types of linkage.
allows more rapid breakdown to individual sugars
.branching creates more ends . paper.Polysaccharides
Cellulose is also a polymer of glucose.
Fiber in the diet. difficult to breakdown. but sugars are linked differently. sheep) with cellulose degrading bacteria
Starch & Glycogen . wood. Extra stomachs in ruminants (cows.
G and T (DNA) or U (RNA) Phosphates .1 (mono).energy GTP . 2 (di) or 3 (tri) Important nts
ATP .A.ribose vs. deoxyribose Base . NADP carry electrons
Sugar .regulates protein activity NAD.C.
Nucleotides are linked together via dehydration synthesis reactions
sugar phosphate backbone bases project to side
RNA has one strand DNA is double stranded
. Linkage by peptide bonds maintains amino and carboxyl termini. directionality 20 different amino acids have “R groups” or “side chains” with different chemical properties.Proteins are polymers of amino acids
Amino acids are connected together to form a chain linked by peptide bonds.
hydrophobic tail + hydrophilic head
.glycerol + 2 fatty acids + phosphate + something else.Phospholipid structure
away from water. Hydrophobic portion in central region.
Lipid bilayers form the basis of membrane structure
. phospholipids spontaneously form a lipid bilayer. exposed to water.Lipid Bilayers
When mixed with water.
Hydrophilic portion of phospholipid on surface.
Triglycerides = Fats/Oils
Triglycerides = glycerol + 3 fatty acids
Function as energy storage and insulation
lard. Unsaturated Fats
maximum number of hydrogens no double bonds more energy storage (more calories) less fluid because straight butter. fat
less than maximum number of hydrogens double bonds present less energy storage more fluid because bent vegetable oils
. estrogen. testosterone. a component of membranes steroid hormones. E.Other Lipids
Isoprenoids . K Sterols
cholesterol. vitamin A.
good cholesterol vs. bad cholesterol
bound to high density lipoprotein (HDL) transports cholesterol to liver blocks synthesis of more cholesterol
bound to low density lipoprotein (LDL) transports cholesterol to cells of the body does not prevent synthesis of more cholesterol by liver
Waxes .fatty acid salt
. hydrophilic part associates with water to allow grease to be washed away emulsification .1 fatty alcohol.allows oil and water to mix often forms micelles
detergents . very hydrophobic
surface of leaves.hydrophobic part associates with grease on your jeans. ear wax
prevents absorption of many fat soluble vitamins that help prevent cancer diarrhea oily anal leakage
.Fat substitutes .Olestra
Olestra = sucrose + 8 fatty acids not absorbed by digestive track Advantage(s)
can be used to fry foods without adding calories negative nutritional value .
All human cells have the same general structure and genetic material. There are seven major functions of cells. Differentiation. causes cells to become specialized.
. or maturation.
Major Functions of Cells
Movement Conductivity Metabolic absorption Secretion Excretion Respiration Reproduction
Tissue refers to a group of cells that perform a similar function. Four basic types of tissue
Epithelial Muscle Connective Nerve
Histology .is the study of tissues
MAIN TISSUE TYPES
Epithelial Connective Muscle Nervous
or covering body surfaces Form many glands
sheets or layers lining body tubes. cavities.
Form sheets, layers Cells fit together tightly One edge attached to basement membrane No blood supply Regenerate quickly Many are secretory Supported by connective tissue
Protection Absorption Filtration Secretion Gas exchange
EPITHELIAL TISSUE TYPES
Number of layers
simple epithelium stratified epithelium pseudostratified epithelium squamous (flat) cuboidal ( cubed) columnar ( tall) transitional (varies)
Shape of cells
“goblet cells” multicellular
modes of secretion apocrine .apex pinches off holocrine .secrete by exocytosis
.Glandular Epithelial Tissue Types
endocrine (ductless) .secrete through ducts to specific locations
unicellular .secrete hormones into blood exocrine.accumulate until rupture merocrine -most common.
Most abundant and widespread tissue found in the body
. fibers.GENERAL CHARACTERISTICS
Many types with great diversity Very good blood supply Cells usually spaced apart from each other Intercellular material (matrix) separating cells No free surface Derived from mesenchyme Consist of ground substance.
Connective Tissue Functions
Physical protection Support Binding Absorb shock Insulation Stores energy Blood production Immunity
very flexible and stretchable
Reticular .forms network mesh
.Types of Fibers
Collagen .very tough and strong
contains collagen protein contains elastin protein contains collagen & glycoprotein
energy storage.binds smooth muscles together
. superficial fascia
Adipose . insulation Reticular .Connective Tissue Proper
Loose Connective(Areolar) .attaches skin to underlying body parts.
Regular dense connective tissue(fibrous)
tendon. lung tissue
. periosteum blood vessels.
connects ribs to sternum external ear
between pubic symphysis discs between vertebrae
. nose tip.Cartilage
Hyaline cartilage (gristle)
ends of long bone.
MATRIX 30% collagen fibers 70% mineral salts
.OSSEOUS TISSUE .
Types of Cells
osteocytes osteoblasts osteoclasts Cancellous (Spongy) Bone .Haversian Canal System
Types of Bone
.trabeculae Compact Bone .
Blood Tissue (Vascular)
Hemopoietic Tissue (blood forming tissue) Types of Cells:
erythrocytes (RBC’s) leukocytes (WBC’s) platelets (thrombocytes)
Contractile tissue Responsible for movement
Usually attached to long bones
Long.Skeletal Muscle . threadlike cells with parallel fibers
Cells are multinucleate with nuclei located peripherally.
Smooth Muscle - Involuntary
Spindle shaped cells with single nucleus per cell No striations Located in blood vessels, walls of hollow organs, and the gastrointestinal tract
Cardiac Muscle .Involuntary
Branched cells with striated fibers Intercalated discs Only a single nucleus per cell Only found in the heart
Characterized by the ability to conduct electrical signals
Located in the brain and spinal cord (CNS) and in the nerves (PNS) Sensitive to changes in the internal and external environment Conducts nerve impulses to other neurons/body parts
Functions in coordinating, regulating, and integrating body activities Types of Cells:
neuroglial cells - support cells neuron - cell body, axon, dendrites
Thin sheet or layer of tissue that covers a structure or lines a cavity
found in closed cavities
parietal membrane .mucosa
line cavities that open to the exterior
Mucous membrane .skin Serous membrane .Epithelial Membranes
Cutaneous membrane .lines inside of cavities visceral membrane .
Connective Tissue Membranes
line spaces between bones in joints secrete synovial fluid
Organs. Organ Systems.
. and organ systems makes up an organism. and the Organism
An organ is a group of tissues functioning together. organs. A group of organs working together is an organ system. tissues. The sum of all cells.
Cardiovascular Respiratory Gastrointestinal Genitourinary Reproductive
Nervous Endocrine Lymphatic Muscular Skeletal
Homeostasis is the body’s natural tendency to keep the internal environment and metabolism steady and normal.
Cells do not tolerate extreme environmental fluctuations.
Two systems work together to maintain homeostasis:
Nervous system response is fast Endocrine response is longer lasting Responses are stimulated by pathological alterations
Chemical signals are received by various types of receptors
Interact with. and then respond to. the chemical signals and other stimuli
Chemoreceptors Baroreceptors Alpha and Beta Receptors
Secrete hormones directly into the circulatory system Secrete hormones directly onto surface Endocrine and exocrine function
Some glands are “mixed”
Hormones distributed throughout the body Secretion of chemical mediators by certain cells that act only upon nearby cells Cells secrete substances that act upon themselves Cells secrete neurotransmitters that transmit signals across synapses
Biological systems generally employ negative feedback loops to maintain stability. A system receiving input creates feedback. A negative feedback loop exists when body mechanisms work to reverse the input.
Stressors on a body system are inputs.
“The physiology of disordered function” Our understanding is constantly expanding During your career you will encounter patient conditions or diseases that were not addressed in your initial paramedic education.
How Cells Respond To Change and Injury
Human cells (except sex cells) reproduce by mitosis Most undergo division throughout the life of the individual
Epithelial cells Liver cells Bone marrow cells Nerve cells Skeletal muscle cells
Copyright © 2006, 2001, 1994 by Mosby, Inc. All rights reserved.
Some divide until near time of birth
somatic cell division in which the cell retains the same number of chromosomes Meiosis .CELL DIVISION
Process by which a cell reproduces itself Involves nuclear division .mitosis. meiosis Involves cytoplasmic division cytokinesis Mitosis .reductional division in which the chromosome number is reduced
centrioles divide Mitosis / Meiosis INTERPHASE
.formation of spindle fibers for cell division.DNA synthesis Growth Phase 2 . proteins and carbohydrates S Phase .CELL CYCLE
Growth Phase 1 .synthesis of lipids.
•STAGES OF MITOSIS PROPHASE METAPHASE ANAPHASE TELOPHASE
Chromatin condenses into chromosomes Spindle Fibers appear Nuclear membrane disappears Nucleolus disappears Centrioles move to opposite poles Chromosomes begins to migrate toward equator
METAPHASE / ANAPHASE
Chromosomes line up along equator centromere of each pair attached to a spindle fiber
Centromeres split. sister chromatids separate Chromatids migrate to opposite poles
TELOPHASE & CYTOKINESIS
Opposite of Prophase Chromosomes elongate forming indistinct chromatin Nuclear membrane reappears Nuclear reorganization occurs Two new daughter cells formed
functions in the process of protein synthesis
.NUCLEIC ACID STRUCTURE
DNA .forms genetic code RNA .
nucleus Contains: 5 carbon sugar.guanine
Base pairing occurs
. nitrogenous base Nitrogenous bases
adenine-thymine cytosine.DNA DEOXYRIBONUCLEIC ACID
Double stranded helix. phosphate group.
each contains an original strand and a newly synthesized strand
.helix molecules are formed.DNA RELICATION
DNA makes an exact duplicate of itself DNA strands separate into separate strands and each one is used as a template for a new strand of nucleotides Two double.
tRNA. nitrogenous base Bases: adenine.RNA RIBONUCLEIC ACID
Single stranded Uracil substitutes for thymine consists of 5 carbon sugar ribose. uracil RNA types: mRNA. cytosine. rRNA
. phosphate group. guanine.
TRANSCRIPTION RNA SYNTHESIS
mRNA is synthesized using a DNA molecule as a template mRNA carries MESSAGE out of the nucleus to the ribsome in the cytoplasm
TRANSLATION PROTEIN SYNTHESIS
Genetic code is translated forming a specific sequence of amino acids mRNA attaches to the ribosomes in the cytoplasm tRNA molecules bring specific A.A. to the ribosome for placement in the dictated sequence Ribosome bonds amino acids together to form proteins / polypeptides Protein is released
uncharged molecules pass through Large or charged molecules cannot pass through hydrophobic part of bilayer
.Loose end .membranes
Lipid bilayer closes to form a sphere (vesicle) Inside of vesicle is a separate compartment Bilayer is “semipermeable”
000 combinations for a 5 aa protein).*******
Hydrophobic amino acids are buried in the center Hydrophilic are on the surface Ionic and H-bonds can form between amino acids
Function is dependent on folded structure. Different amino acids have different chemical properties.200. which is dependent on sequence of amino acids.Loose end– protein folding
Proteins are incredibly diverse – 20(# of amino acids) possible combinations (3. causing polypeptide chain to fold up on itself.
Loose end– enzymes
Enzymes are proteins that catalyze (stimulate/ accelerate) chemical reactions Names end in -ase Examples
DNA polymerase makes DNA ATPase breaks down or produces ATP Helicase unwinds the DNA double helix
Metabolic pathway is a series of reactions that produces (anabolic) or breaks down (catabolic) a molecule in the cell
Defects cause genetic diseases
What is information?
Representation of knowledge.Info Flow . series of symbols that have meaning. Digital – 1’s and 0’s Alphanumeric – letters and numbers Graphic – illustration Genetic – chemical – order of bases (ACGTU) in a nucleic acid tells a cell how and when to make specific proteins – which then perform some function for the cell.
Genes .Storage of Information
Information is stored in the sequence of bases in DNA.instructions on how to make proteins
hemoglobin gene contains the information on the order of amino acids that are linked together to make hemoglobin
Regulation .when and where to make proteins
only bone marrow cells make hemoglobin
DNA = deoxyribonucleic acid
Sugar = deoxyribose Base –
Purines (2 rings) = A. T
Phosphate – negative charge – gives DNA a negative charge
. G Pyrimidines (1 ring) = C.
Nucleotides are linked together via dehydration synthesis reactions
sugar phosphate backbone bases project to side
Bases can form Hbonds
C’s and G’s pair A pairs with T or U
Two strands of DNA are said to be complementary Strands are antiparallel. have 5’ phosphate & 3’ OH 5’-GCTAGGTAGTCCT-3’ 3’-CGATCCATCAGGA-5’
. different form (cursive) Translation: RNA protein nucleotide seq. amino acid seq.still same letters.The Central Dogma
Information Flow within Organisms What Information? Replication: DNA DNA exact copy .photocopy Transcription: DNA RNA still a sequence of nucleotides writing notes from screen .
U in RNA
. RNA polymerase uses 1 strand of DNA as a template to make mRNA.C. Starting position determined by RNA polymerase binding to PROMOTER RNA polymerase moves down DNA and connects nucleotides to make RNA bases .Transcription
Messenger RNA (mRNA) functions as a “working copy” of the information on DNA.A.G in both RNA and DNA. T in DNA.
RNAs may contain info from multiple gene – produce multiple proteins
. RNA molecule is released in eukaryotes .each RNA contains the info from 1 gene – produces 1 protein in prokaryotes . the 2 DNA strands come back together.Transcription
After RNA is made.
Once transcription does occur. RNA is processed to form mRNA before export from nucleus to cytoplasm
. RNA produced referred to as “primary transcript” In Eukaryotes.
. exons are spliced together. parts that will be used to make protein are exons. Introns are cut from primary RNA transcript.RNA splicing
Eukaryotic genes are interrupted by DNA sequences called introns or intervening sequences.
Poly-A tail added to 3’ end to enhance stability of mRNA 7-methyl-guanine “cap” added to 5’ end – required for export from nucleus
.sequence of 3 nucleotides that specifies 1 amino acid. AUG=start codon UAA. UAG are stop codons.The Genetic Code
What is a code? Morse Code The genetic code translates nucleotide sequence into amino acid sequence
codon . UGA.
but only 20 amino acids.same for all organisms
. Most amino acids are encoded by multiple codons
The Genetic Code is Universal .64 possible combinations.The Genetic Code
Genetic code is degenerate .
notoverlapped.The Genetic Code
Codons are read sequentially. 3 Possible Reading Frames
AUG GGA UCC ACA UUU GCA UGA Met Gly Ser Thr Phe Ala Stop A UGG GAU CCA CAU UUG CAU GA Trp Asp Pro His Leu His AU GGG AUC CAC AUU UGC AUG A Gly Ile His Ile Cys Met
The Big Picture
5S rRNA and 45 proteins
rRNAs are functional components. proteins provide scaffolding
Translation occurs on ribosomes Ribosomes are ribonucleoproteins (RNA and protein components)
Small subunit contains 16S rRNA and 33 proteins Large subunit contains 23S rRNA.
mRNA function is information transfer – info is used to make protein Some RNAs are not translated – tRNA. rRNA Intramolecular base pairing causes RNA to fold into a specific shape (like a protein) Paired regions twist to form helix
Transfer RNA (tRNAs) are the adaptors that associate RNA codons with amino acids
anticodon at one end base pairs with codons on mRNA. amino acid at other end attached by amino acyltRNA synthetases Each amino acid has 1-2 tRNAs
tRNA that base pairs with next codon is lined up. 3.Translation
1. 4. Two amino acids are connected. 2. position start codon.
Ribosomes bind mRNA.
. Initiator tRNA base pairs with AUG codon.
New tRNA pairs with next codon. Return to step 4
4. 6. Ribosome moves down mRNA to next codon.
Two amino acids are connected. 5.
When ribosome reaches a stop codon . folds into a functional protein. Polypeptide is released. See animation
.no tRNAs can pair with it.
Amino acids connected to produce protein
.The Big Picture
DNA is transcribed to mRNA. tRNAs with amino acids pair up with codons on mRNA. Ribosome binds mRNA.
How Cells Respond To Change and Injury
Cellular Adaptation Cellular Injury Cellular Death
Adaptation results in alteration of structure and function. tissues. organs.Cellular Adaptation
Cells. and organ systems can adapt to both normal and injurious conditions. Many of these cellular adaptations are successful.
May also be part of the process of a disease
Types of Cellular Adaptations
Decreased size resulting from a decreased workload An increase in cell size resulting from an increased workload
An increase in the number of cells resulting from an increased workload
Types of Cellular Adaptations
Replacement of one type of cell by another type of cell that is not normal for that tissue A change in cell size. or appearance caused by an external stressor
Hypoxic Chemical Infectious Immunologic or Inflammatory
Physical agents Nutritional balances Genetic factors
Results in anaerobic metabolism Cell and some of its organelles then begin to swell
Reversible if intervention is early
Infarction occurs if no intervention
Usually a deficit in the respiratory or cardiovascular system Blockage or reduction of blood flow to a cell may result in ischemia.
carbon monoxide.Cellular Injury
Cellular injury due to chemical products is very common.
Heavy metals. ethanol. and insecticides are examples Disruption of the cellular membrane Alteration of coagulation Death of the cell
fungi. and the body’s ability to contain or destroy it
. and parasites Majority are harmless
Pathogens cause disease
Degree of damage depends on the pathogens numbers. its virulence. viruses. prions.Cellular Injury
Caused by bacteria.
Hypersensitivity Anaphylaxis An immune response may harm healthy cells as well as damaged cells.
Protective responses of the body can cause cell injury and even death.
Injurious Physical Agents
Extreme variances in temperature Atmospheric pressure changes Exposure to ionizing radiation Illumination Noise Mechanical stresses
Injurious Nutritional Imbalances
Excessive intake of saturated fats and cholesterol Excessive carbohydrate (glucose) intake Insufficient intake of nutrients
Injurious Genetic Factors
Some cellular dysfunctions are caused by genetic predisposition. or the transport mechanisms that carry substances across the cell membrane. the receptors on the cell membrane. the shape of the cell. The interaction of genes and environmental factors determine that person’s development.
. This can involve alterations to the nucleus or the cell membrane.
.Manifestations of Cellular Injury
When cells are injured metabolism is changed. causing substances to infiltrate or accumulate to an abnormal degree in cells and tissues. The most commonly seen effects of cell injury and accumulation are cellular swelling and fatty change.
Manifestations of Cellular Injury
Results from a permeable or damaged cellular membrane Caused by an inability to maintain stable intraand extra-cellular fluid and electrolyte levels Lipids invade site of injury Ominous sign of impending cellular destruction
Manifestations of Cellular Injury
Systemic Signs and Symptoms of Cellular Change
Fatigue and malaise Altered appetite Fever Increased heart rate associated with fever Pain
cells shrink Apoptosis has specificity
Contained to specific cells or areas
The body’s way of ridding itself of destroyed or nonfunctional cells Result of both normal and pathological tissue changes In apoptosis.
. caseous.Cellular Death
A pathological process Cells swell and rupture Necrotic tissue changes