生理學4th term

###### tags: `生理學` # 生理學4th term # CH14 ## Urinary system anatomical structures :::danger **考哪一個不是Urinary system** - **Ureters(輸尿管)**: transport urine from kidneys to bladder - **bladde(膀胱)** : stores urine until voided from body - **Urethra(尿道)**: carries urine from baldder to the outside of the body ::: ## Nephrons (腎元) :::danger **考 What is structural and functional unit of the kidney 答案: Nephron** ::: - **Nephrons** are structural and functional **units of the kidney** and each kidney **has over 1 million** of them - Each **nephorn** consists of an **initial filtering component** called the **renal corpuscle** and **tubule** that extends from the renal corpuscle - Each **renal corpulse contains** a compact tuft of interconnected capillary loops called the **glomerulus** or **glomerular(腎絲球)** **(85%)** - The **glomerulus protrudes into** a fluid-filled capsule called **Bownman's capsule(包氏囊)** ## The reanl Corpuscle - a single-celled epithelial lining of Bowman's capsule. The cells here are called **podocytes** - modified **smooth muscle** cells called **mesangial cells**. These cells **help regualte the blood flow in the glomerulus** by contraction ## Capillaries Associated with Nephrons - **glomerular filtration rate(GFR)**, which is the **volume of plasma filtered** from the **glomerular capllaries into bowman's space** per unit time ## Cortical versus Juxtamedullary nephrons :::danger - **Juxtamedullary Nephorns** - **Long loops of Henle** - About **15%** of all in this categoty - In close promimity with **vasa recta**, which are long blood vessels running alongside the loops of henle - **Cortical Nephrons** - **Short or no loops of Henle** - Most nephrons are in this category(**approximately 85%**) - Do not contribute to the hypertonic medullary interstitium ::: ## Juxtaglomerular Apparatus(近腎絲球胞器) :::danger - **juxtaglomerular (JG)** cells. When stimulated by a decrease in stretch, these cells **secrete renin(腎素)** - The **macula densa(緻密斑)** cells sense **changes in the NaCl content** of the filtrate and also **help to regulate sodium blance and blood pressure** ::: - **juxtaglomerular apparatus(JGA) = macula densa and juxtaglomerular cells** ## The Three basic components of Renal function :::danger - Glomerular filtration - Tubular secretion - Tubular reabsorption (all of above) ::: ## Glomerular filtration - **This reuslts in a GFR of 180 liters/day versus 4 liters/day filtered by the rest of the systemic capillary beds** - **Blood cells(hematuria 血尿) or protein in the urine (proteinuria 蛋白尿)** indicate potential **problems** with the glomerular **filtration barrier,** and are common findings in certain **disease** states ## Tubular Reabsorption of Sodium :::danger - **Na+** is the most abundant cation in the filtrate ::: ## Tubular Secretion (分泌作用) - Substances such as **hydrogen ion, potassium, and organic anions** move from the peritubular capillaries into the tubular lumen by tubular secretion :::danger Tubular secretion is an importan mechanism for: - disposing of drugs and drug metabolites - eliminating undesired substances or end-products that have been reabsorbed by passive proceses(urea and uric adic) - removing excess K+ - controlling blood pH ::: ## Metabolism by the Tubules - Renal tuble cells can **synthesize glucose** during fasting and add it to the blood - They can also **catabolize** certain organic substances, such as **peptides**, taken up from either the tubular lumen or peritubular capillaries. ## Reanl Clearance(RC) 腎清除率 - **Inulin** is a substance that is **freely filtered** by the kidney, but it is **not reabsorbed nor secreted** ## Micturition(排尿) :::danger - The urine is stored in the bladder and intermittently ejected during urination or **micturition** ::: - The bladder is a ballonlike chamber with walls of smooth muscle collectively termed the **detrusor muscle**. - at the base of the bladder where the urethra begins functions as **internal urethar sphincter** - a ring of skeletal muscle surrounds the urethra. This is the **external urethrtal sphincter** - The bladder muscles are **innervated by parasympathetic, sympathetic and somatic motor neurons**(exteranl urethral sphincter) ## Control of the bladder ![](https://i.imgur.com/jX8CB2f.png) ## Incontinence (尿失禁) - **Incontinence** is the involuntary release of urine - **stress incontinence(壓力性)** (咳嗽一下、運動就直接尿出來 - **urge incontinence(緊急性)**(想要尿的時候忍不住就直接出來) - **Urge incontinence** can be treated with drugs such as **tolterodine or oxybutynin**, which antagonize the effects of the **parasympathetic nerves** ## Basic renal processes for sodium and water :::danger - Water reabsorption is by **osmosis (passive)** - Water move through **aquaporin channels(水通道)** - They are highly expressed in the **proximal tubules** - They are virtually(幾乎) absent in the collecting ducts unless **antidiuretic hormone(ADH)抗利尿激素** ::: ## Mechanism of Na+ Reabsorption in the proxiamal tubule :::danger tight juntion ![](https://i.imgur.com/jg36jh1.png) ::: ## Hyperosmotic Medullary Interstitium - At least five factors contribute to the creation of a **hyperosmotic medullary interstituim** - the countercurrent anatomy of the loop of Henle of juxtamedullary nephorns - reabsorption of NaCl in the ascending limbs of those loops of henle - impermeability to water of those ascending limbs - trapping of urea in the medulla - hairpin loops of vasa recta to minimize washout of the hyperosmotic medulla Maybe all of above ## Control of Sodium Reabsorption :::danger **考哪裡分泌Aldosterone** ::: :::danger Summary of the Renin–Angiotensin System and the Stimulation of **Aldosterone** Secretion by Angiotensin II **Aldosterone** ::: ## 58 - **Osmoreceptor**, Pathway that **decreases vasopressin secretion and increases water excretion** ## 64 :::danger Increased Potassium Intake Induces Greater 𝐊+ Excretion **Aldosterone** ::: ## Diuretics - **diuretics. They are used to prevent or reverse the renal retention of Na+ and water** - **Osmotic diuretics such as mannitol are filtered but not reabsorbed** ## Renal Mechanisms - H+ concentration decreases (alkalosis) - H+ concentration increases(acidosis)酸中毒 ## Chanes in the arterial concentrations of H+, HCO3-, and Cardbon Dioxide in Acid-Base Disorders ![](https://i.imgur.com/C1NqGk9.png) ## Kidney Disease :::danger - Bacterial infections - Hypertension - Diabetes End stage renal disease is one of the leading causes of death in the world and is the leading cause of **renal transplants** ::: # CH 15 ## Functions of the Digestive System All of above :::danger 1. Ingestion of foods and liquids containing nutrients 2. Digestion of large molecules in ingested food into absorbable molecular forms 3. Absorption of nutrients from the gut into the internal environment 4. Metabolic transformation of fuel molecules and detoxification of foreign substances (liver) 5. Elimination of small amounts of metabolic end products secerted by the liver 6. Carrying out a variety of immune functions, including production of antibodies and fighting infectious microorganisms not destroyed by the acidity of the stomach ::: ## How are Gastrointestinal Processes Regulated? 1. Gastrointestinal system are **governed by the volume and composition** 2. This means that the body is designed to abosrb all the nutrients that are ingested 3. **Gastorintestinal reflexes** ## Neural Regulation of Gastrointetinal Processes 1. The GI tract has its **own local neural control**, a division of the autonomic nervous system known as **enteric nervous system**, **myenteric and submucosal** 2. efferent neurons from both the **sympathetic and parasympathetic branches of the autonomic nervous system** enter the intestinal tract and synapse 3. Two types of neural-reflex arcs exist: (1) **short reflexes** , (2) **long reflexes** ## Hormonal Regulation of Gastrointestinal Processes - The hormones that control the gastrointestinal system are secreted mainly by **enteroendocrine cells** - The four best-understood GI hormones are **secretin, cholecystokinin(CCK), gastrin, and glucose-dependent insulinotropic peptide(GIP)** ## Phases of Gastrointestinal Control - **Cephalic Phase**: Initiated when sensory receptors in the head are **stimulated by sight, smell taste and chewing**. - **Gastric Phase**: stimulate responses that are mediated by short and long neural reflexes and by release of the hormone gastrin. - **Intestinal Phase**: Initiated by stimuli in the small intestine. CCK,GIP ## Components and Functions of Saliva(唾液) - Water - Mucus (潤滑液) - HCO3- - Lysozyme - **Amylase** > **Begins the digestion of polysaccharides** - **Lipase** > **Begins the digestion of triglycerides** ## The Two Regions of the Stomach: **Body and Antrum** :::danger **這裡有考body分泌什麼** - Body (secretes mucus, pepsinogen, and **HCl**) - Antrum (secretes mucus, pepsinogen, and **gastrin**) ::: ## A Gastric Gland in the Body of the Stomach :::danger **分泌了什麼一定要知道，這裡考兩題** - Mucous cells (mucus, bicarboante secretion) - **Parietal cells** (**acid-HCl**, intrinsic factor secretion) - ECL cell (histamine secretion) - **Chief cells** (pepsinogen secretion) ::: ## Anatomy of the small intestine - One of the specialized anatomical structures are the **circular folds**(surface area specializations of the mucosa and submucosa) :::danger **有考乳糜管** - **Villi**(絨毛) increase surface area and **contain blood vessels and lacteals(乳糜管)** which function in the absorption of nutrients ::: - each villus is covered with a **microvilli**(singular, microvillus, also known collectively as a **Brush border**) ## Portal system :::danger - **Sphincter of Oddi** > Gallbladder(膽囊) 進到腸胃 - **Duodenum** > 開口在十二指腸 ::: ## Pancreatic Sercretions - The pancreas **has both exocrine and endocrine functions**. The **exocrine portion** of the pancreas **secretes HCO3- and a number of digestive enzymes into the duodenum** - The enzymes are secreted from **lobules** called **acini**;the cells are thus referred to as **acinar cells** ## Liver - **Exocrine secretions** from the liver enter the small intestine and are essential from normal digestion :::danger **有考哪裡分泌bile** - One of **major function** of the liver: **secrete bile** ::: - Bile **contains HCO3-, cholesterol, phospholipids, bile pigment, a number of organic wastes**, and a group of substances collectively termed **bile salts** - The **HCO3- helps neutralize acid form the stomach**, whereas the **bile solubilize dietary fat.** ## Enterohepatic Circulation - This recycling pathway from the liver to the intestine and back to the liver is known as the **enterohepatic circulation** ## Carbohydrates - monosaccharides(單醣) ## Proteins :::danger 第一點最重要 - Proteins are **broken down to peptide fragments** in the **stomach by pepsin(胃蛋白酶)**, and in the **small intestine by trypsin and chymotrypsin**, the **major proteases sereted by the pancreas** - peptide fragments are digested to **free amino acids** by **carboxypeptidases from the pancreas** and **aminopeptidases from small-intestine ephithelial cells** **有考free amino透過什麼進入epithelial cells** - The **free amino acids** then enter the epithelial cells by secondary **active transport coupled to Na+** ::: ## Emulsification (乳化作用) ## Fat Digestion by Lipase Fat Digestion: - Lipase - Bile salt ## Vitamins :::danger **這裡有考哪一個不是Fat-soluble** - Fat soluble vitamins (A, D, E, K) - Water-soluble vitamins (B12, C) ::: ## Pathophysiology of the Gastrointestinal Tract :::danger **有考** All of above 1. Ulcers 2. Vomiting 3. Gallstones 4. Lactose Intolerance 5. Constipation and Diarrhea 6. Inflammatory Bowel Diease ::: ## Ulcers :::danger - One major factor, however, is the presence of bacterium(細菌), **Helicobacter pylori** that is present in the stomachs of many patients with ulcers or gastritis(inflammation of the stomach walls) ::: # CH16 ## Increase or a Decrease in the Plasma Concentration of Insulin :::danger **有考Insulin是什麼** - **Glucagon** - Islets of **alpha** Langerhans - **Insulin** - Islets of **beta** Langerhans - **Somatostatin** - Islets of **delta** Langerhans ::: ## Cortisol - Increased plasma concentrations cause: - Increased protein catabolism - Increased gluconeogenesis - Decreased glucose uptake by muscle cells and adipose-tissue cells - Increased triglyceride breakdown ## Growth Hormone - similar to cortisol and oppostie those of insulin 1. Increases the responsiveness of adipocytes to lipolytic stimuli 2. stimulates gluconeogenesis by the liver 3. reduces the ability of insulin to stimulate glucose uptake by muscle and adipose tissue - **anti-insulin effects** ## Hypoglycemia (低血糖) - Hypoglycemia is broadly defined as an **abnormally low plasma glucose concentration** - **Fasting hypoglycemia** due to: - an **excess of insulin** due to **an insulin-prodcing tumor, drugs** - defect in one or more **glucose-conterregulatory controls** ## Eating Disorders: :::danger - **anorexia nervosa**厭食 : **decreased food intake** so severely that the person may die of starvation - **Bulimia nervosa**暴食: **recurrent episodes of binge** eating with regular self-induced vomiting,use of laxatives or diuretics, strict dieting or fasting, or vigorous exercise to lose weight or prevent weight gain. ::: ## Circadian changes in core as body temperature in a typical person :::danger 剛起床體溫最低36.5 4~8點體溫最高37.5 ::: ## Mechaisms of Heat transfer :::danger all of above - Convection - Radiation - Evaporation - Conduction ::: # CH17 ## An Overview of Gametogenesis in the Testes and the Ovary :::danger ![](https://i.imgur.com/JjGuEMx.png) 差別: - **Testis**(睪丸)->First **meiotic**(減數分裂)->Homologous chromosome pairing->**Secondary spermaticyte** - **Ovary**(卵巢)->First **meiotic**(減數分裂)->Homologous chromosome pairing->**Secondary oocyte** and **First polar body** ::: ## Differentiation of the Gonads :::danger - **SRY gene** located on the **Y chormosome** , which lead to **testes** in the males ::: ## Embryonic Sex Differentiation of the Male and Female Internal Reproductive Tracts - Woiffian duct (發育成男孩子) - Mullerian duct (發育成女孩子) ## Summary of Sex Differentiation :::danger ![](https://i.imgur.com/xlEmn2u.png) 有考試哪一個cell做Spermatogenesis精子形成 - Primordial gonads - **Sertoli cells** > Mullerian inhibit - **Leydig cells** > Testostreone ::: ## Section of a Testis :::danger - Luteal Hormone (LH) -> Leydig - Follicle Stimulant Hormone (FSH) -> Sertoli ::: ## Spermatogenesis 精子形成 - The **Sertoli Cells** Form a Ring (Barrier) Around the Entire Tubule ## Ejaculation(射精) - Ejacualtion is primary a **spinal reflex** mediated by afferent pathways form **penile mechanoreceptors** - result of **sympathetic nerve stimulation** - 3 milliliters and containing 300 million sperm ## Puberty (青春) :::danger **這題有考** - **males 12~16 years** - **female 10~12 years** ::: ## Andropause (雄老化) - There is a **steady decrease in testosterone secretion, beginning at about 40 years** of age - With aging, **increased emotional problems** such as depression, this is sometime referred to as **the andropause(male climacteric)** ## Effects of Testosterone :::danger - Stimualtes erythropoietin secretion by the **kidneys** ::: ## Ovarian functions - **Oogenesis**(卵子形成), the production of gametes during the fetal period - Maturation of the oocyte - Expulsion of the mature oocyte (**ovulation 排卵**) - **Seretion** of the female sex steroid hormones (**estrogen and progesterone**) ## Summary of Oogenesis (卵形成) :::danger ![](https://i.imgur.com/CLetXrq.png) - Mitosis Differentiation - 1st meiotic division (begins in utero completed prior to ovulation) - **2nd meiotic division (completed after fertilization)** ::: ## Menstrual Cycle ![](https://i.imgur.com/Jnujt4c.png) - Follicular phase - Luteal phase :::danger ![](https://i.imgur.com/2oZrewY.png) **有考這個過程** - **Proliferative, secretory, menstrual** ::: ## Major feedback effects of Estrogen, Progesterone, and Inhibin - **Estrogen**, in **low plasma concentration**, the **anterior pituitary sercrete less FSH and LH** in response to GnRH. - Result: **Negative** feedback **inhibition** of **FSH and LH** secretion during the early and middle follicular phase - **Inhibin** acts on the **pituitary gland** to **inhibit** the secretion of **FSH** - Result: **Negative** feedback **inhibition** of **FSH** secretion. - **Estrogen**, **when increasing dramatically** causes **anterior pituitary gland cells to secrete more LH and FSH** in response to GnRH - Result: **Positive** feedback **stimulation** of the **LH** surge, which **triggers ovulation**. - **High plasma concentrations of progesterone, in the presence of estrogen**, **inhibit** the **hypothalamic** neurons that **secrete GnRH** - Result: **Negative** feedback **inhibition of FSH and LH** and **prevention of LH surges** during the **luteal phase and pregnancy** ## Control of ovarian :::danger ![](https://i.imgur.com/Z5Li2Z6.png) - FSH: Granulosa cells > Granulosa cells convert androgens to estrogen - LH: Theca cells > Theca cells synthesize androgens ::: ## Menopause (停經) :::danger **有考停經是什麼** ::: - The phase of life during which menstrual irregularity begins is termed **perimenopause**. - menstrual cease entirely in all woemn;this cessation is known as **menopause** ## Fertilization(受精) and Early development - Egg transport - Intercourse, Sperm transport , and Capacitation :::danger **Fertilization** in **Fallopian tube(輸卵管)** 有考在輸卵管著床的時期的單字 ::: ## Events leading to fertilization :::danger ![](https://i.imgur.com/TgIiTPp.png) - Egg compltes 2nd meiotic division ::: ## Parturition (生產) ## Lactation (泌乳) ## Infertility (不孕症) - 6% to 15% - in vitro fertilization, success rate 40% # CH18 ## Innate Immune Responese (先天性免疫反應) :::danger All of above The following are involeved in innate immune responeses: - Defenses at body surfaces - Inflammantion - Interferons - Toll-like receptors ::: ## Defenses at body surfaces The body's first lines of defense are barriers offered by **surfaces**. :::danger **這有考** Example: **Skin** and mucous membranes ::: ## Complement System - The central protein in the complement cascade is **C3**. - Its activation eventually leads to the downstream development of a **multiunit protein** called **membrane attack complex(MAC)** ## Adaptive Immune Responese (後天性免疫反應) - Any **molecule** that can **trigger an adaptive immune response against itself** or the cell bearing it is call and **antigen** - adaptive immune respoense can be divided into three stages: - The encounter and recognition of an antigen by lymphocytes - Lymphocyte activation - The attack launched by the activated lymphocytes and their secretions ## Lymphoid Organs :::danger **有考: What is NOT in secondary lynphoid organs** - **Primary Lymphoid organs**: - Bone marrow (骨髓) - Thymus (胸腺) - **Secondary lymphoid organs:** - Spleen (脾臟) - Lymph nodes - Tonsils - Adenoids - **Lymphocyte** accumulations in the linings of the intestinal, respiratory, gential, and urinary tracts ::: ## Immunoblobulin Structure :::danger ![](https://i.imgur.com/eSwTfn4.png) **有考在哪裡binding** - Two heacy chains Two light chains - Two antigen-binding sites - Constant region- same within a class of antibodies - variable region - differs for different antigens, give specificity to antigen-binding site ::: ## Major Histocompatibility Complex (MHC) Proteins - complexed with the antigen in order for **T-cell recongnition** to **occur** constitute a group of **proteins coded** for **by genes** found on single **chromosome 6** and known as **major histocompatibility complex (MHC)** ## MHC Protein Classes :::danger There are two calsses of MHC proteins: - **Class I MHC proteins** are found on the surface of **virtually all cells of the body except erythrocytes** - **Class II MHC proteins** are found mainly on the surface of **macrophages, B cells, and dendritic cells** ::: ## MHC Restriction of the Lymphocyte Receptors - B: Do not interact with MHC proteins - Helper T: Class II, found only on macrophages, dendritic cells, and B cells. - Cytotoxic T: Class I, found on all nucleated cells of the body. - NK: Interaction with MHC proteins not required for activation ## Processing and Presentation of Viral Antigen to a Cytotoxic T cell by an Infected Cell :::danger **這題有考** ![](https://i.imgur.com/sgF7Jdl.png) Cytotoxic=> CD8 ::: ## NK cells (Natural Killer cell) NK cells are a **class of lymphocytes**, whose major targets are **virus-infected** cells and **cancer cells** ## development of Immune Tolerance - **Immune tolerance** develops during fetal and early postnatal life **due to clonal deletion or clonal inactivation** ## Antibody :::danger **有考anitbody是什麼** ::: ## Antibody Function in Humoral Immunity - The antibody functions to bind the specific antigen, which leads :::danger There are 5 classes of antibodies: - IgG - IgM - IgE - IgD - IgA (母乳含量很高，給小孩子的仙丹) ::: ## The attack: Effects of Antibodies :::danger All of above - Direct enhancemnet of phagocytosis - Activation of the complement system(補體活化) - Antibody-dependent cellular cytotoxicity - Direct neutralization of bacterial toxins and viruses ::: ## Antibody production - Antibody production occurs slowly over several weeks following the first contact with an antigen, but any infection by the **same invader** elicits an **immediate and considerable outporing of additional specific antibodies**, **which is mediated by the memory B cells** ## **Memory** :::danger - **Primary immune response**(1st exposure) - Generally takes **10~17 days** to occur after exposure(潛伏期) - Symptoms of illness occurs during these days - Antigen-selected **B and T cells** proliferate and differentiate into effector cells - **Secondary immune response**(all other exposures) - Takes **2~7 days** to occur - Greater response - Occurs due to **memory cells** ::: ## Active Immunity - Body's contect with microoranisms and their toxins or other antigenic components(from a infection or vaccine) is known as **active immunity** ## Passive Immunity - passive immunity, is simply the direct **transfer of antibodies from one person to another**. - Such transfer occur between mother and fetus because **IgG can move across the placenta** - **a breast-fed child receives IgA** antibodies in the mother's milk - **These are important sources(IgG, IgA) of protection for infant** ## Immunodeficiency Diseases(免疫不全疾病) Immunodeficiency disease result from weak, under-active, or impaired immune systems - SCID = Serve combined immunodeficiencty disease: **absence** of both **B and T cells**, in some cases, NK cells - AIDS = Acquired Immunideficiency syndrome: **attack helper T cells** > **Human immunodeficiency virus** (HIV) infects and **kills helper T** ## Harmful Immune Responses :::danger - Graft rejection (排斥作用) - Transfusion Reactions (輸血反應) - Allergy (Hypersensitivity)過敏 - Autoimmune disease (自體免疫疾病) - Excessive Inflammatory Responses (過度發炎反應) ::: ## Tissue Grafts(組織移植) and Organ Transplantation(器官移植) - The MHC proteins of **both classes are recognized** as **foreign by** the recipent's **T cells**, and cells bearing these **proteins are destroyed by recipient's cytotoxic T cells with aid of helper T cells** :::danger - A **very effective drug, cyclosporine**, which does not kill lymphocyes but rather **block the production of IL-2 and other cytokines by helper T cells** > This **eliminates** a critical signal for proliferation of both the **helper T cells** thenselves and the **cytotoxic T cells** ::: ## Transfusion Reactions - Transfusion Reaction is the illness causes **when erythrocytes are destroyed during blood transfusion** - **Antibodies** rather than cytotoxic T cells are **sometimes the major factor in rejection** - **Erythocytes do not have MHC proteins**, **but** they do **have plasma membrane proteins** and **carbonhydrates** that can function **as antigens** - The **ABO system of carbohydrates** is the most **important for transfusion reactions** - erythrocyte membrance antigens: **Rh system of proteins** ## Anaphylaxis (無防禦性休克) :::danger **有考mast cell** - if very large amounts of the **chemicals(histamine) released by the mast cells (or blood basophils)** enter the circulation, systemic symptoms **may** result and cause severe **hypotension and bronchiolar constriction** - This sequence of events, called **anaphylaxis**; can cause death due to circulatory and respiratory failure ::: ## Autoimmune Disease **Autoimmune disease** is **due to an inappropriate immune attack** triggered by the body's own proteins acting as antigens :::danger Examples: **有考** - Type 1 diabetes mellitus (第一型糖尿病) - Rheumatoid arthritis (風濕性關節炎) - Multiple sclerosis (多發性硬化症) - Myasthenia gravis (重肌症無力) :::