Digestive System (Gastrointestinal tract)

What is the purpose of the digestive system? To obtain

1. water
2. energy substrates
3. tissue components (amino acid)
4. vitamins
5. minerals (k+, Na+)

How does it accomplish this? (IMSDAE)
Ingestion (introducing material into the mouth)
Mechanical processing (chewing, swallowing, mixing and propulsive movements)
Secretion (release of water, acid, enzymes into the gut)
Digestion (enzymatic breakdown of macro- molecules in food)
Absorption (uptake of nutrients from the gut)
Excretion (elimination of wastes in feces)

What are the layers of the GI tract?
Mu - Mucosa: lines the GI tract
Su - Submucosa (Enteric NS)
Mu - Muscularis Externa
circular
longitudinal (toothpaste)
Se - Serosa: slippery (lubrication; decrease friction)

How are these layers different in the esophagus? Stomach? Large intestines?
ESOPHAGUS
Mu - ////
Su - Submucosal plexus/Meissners= secretions
Mu - (Averbachs) Myenteric Plexus= motility
Se -Tunica Adventitia Fixed

STOMACH
Mu - Mucosal
Su - submucosal plexus (Meissners)
Mu - muscularis:
circular
longitudinal
oblique
Se- Serosal
LARGE INT.
Mu - absorb nutrients and water and pass to blood
Su - has blood vessels / connective tissue to support Mucosa (Meissners)
Mu - Peristalsis (Averbachs)
Se - slimy
What is peristalsis?
contraction throughout the whole GI tract (propulsive movements)
What are the two layers of the muscularis externa?
1. circular
2. longtidudinal
What nervous system controls the GI tract?
Enteric Nervous System
o Extrinsic? NO
o Intrinsic? YES

How does the sympathetic nervous system affect the GI tract?
Sympathetic: kicks in only during exertion, stress, or emergency; fight or flight; gas (stressed);
T1-L2 ejaculation ;
Increased Metabolic Rate
**Reduced digestive & urinary functions
Energy reserves activated
Increased respiratory rate & respiratory passageways dilate
Increase heart rate & blood pressure
Sweat glands activated

Parasympathetic nervous system?
Parasympathetic: rest & digest, controls resting conditions
Decreases Metabolic Rate
Decrease heart rate & blood pressure
**Increased secretion by salivary & digestive glands
**Increased motility & blood flow in digestive tract
Urination & defecation simulation

What are the two divisions of the enteric nervous system?
1. submucosal plexus (Meissners)
2. myenteric plexus (Averbachs)
o Which is associated with secretion? Meissners
Motility? Averbach
What are the parts of the GI tract? Functions?
o Esophagus: Transport materials to stomach
o Stomach: chemical breakdown via acid and enzymes; mechanical processing through
muscular contractions; very little absorption; sense volume and comp of chyme
o Small intestines: enzymatic digestion & absorption of water, organic substrates, ions,
and vitamins
o Large intestines: dehydration and compaction of indigestible material for elimination
o Liver: secretion of bile (imp. for lipid digestion), storage of nutrients, and other fxns
o Gallbladder: storage and concentration of bile
o Pancreas: exocrine cells secrete buffers and digestive enzymes; endocrine cells secrete
hormones
o Gastric and enteric cells: see below

What membrane lines the abdominal cavity? Peritoneum
Parietal? lines the wall
Visceral? lines the organ
ABDOMINAL CAVITY
What is the lesser omentum? Where from and to?
part of peritoneum that extends from the liver to the stomach
What is the greater omentum? Where from and to?
fold of peritoneum that extends from the stomach to the colon
hangs down from the stomach
What is the mesocolon? Where from and to?
fold of peritoneum connecting the transverse colon to the posterior wall of the
abdomen
What is the mesentery? Where from and to?
a fold of the peritoneum that attaches the stomach, small intestine, pancreas,
spleen, and other organs to the posterior wall of the abdomen

Salivary glands: parotid, sublingual, submandibular

Teeth: (How many on top? On bottom? Of an adult?)
CHILD: (20)
Incisors: TOP: 4 //BOTTOM: 4 = 8 (2 central//2 lateral)
cuspids: 2 // 2 = 4
premolars: none
molars: 4 // 4 =8

ADULT: (32)
Incisors: TOP: 4 //BOTTOM: 4 = 8
canines: T: 2// B: 2 =4
premolars: 4 // 4 =8
molars: 6 // 6 =12

ESOPHAGUS
o Which part has skeletal muscle (voluntary)? Upper third (middle part is mixed)
Smooth muscle (involuntary)? lower third
o Where do you find glandular epithelium? Stomach or esophagus? Why?
Esophagus; glandular epithelium secretes goblet cells that secretes mucus making it
easier for the transportation of food
o Where do you find stratified squamous epithelium? Stomach or esophagus? Why?
Esophagus: for protection from abrasion of material
o What is the lower esophageal sphincter also called?
cardiac sphincter/gastroesophageal
What happens when the LES does not do its job?
GERD occurs (Gastroesophageal Reflux disease)
heat burn
indigestion
acid reflux
stomach acid moving to esophagus
STOMACH:
o Parts
What are rugae? (temporary) series of expandable folds located on the interior surface of
the stomach.
flatten for expansion
What is the sphincter at the bottom of the stomach? Pyloric sphincter
What attaches to the lesser curvature? lesser omentum
Greater curvature? Greater omentum
o Which of the 4 layers of the GI tract are different in the stomach? muscularis externa

o What do these cells secrete?
Parietal: HCl acid, IF (intrinsic factor)
Chief: pepsinogen (need acid), pepsin
Mucous: mucus
G cells: stimulate chief and parietal cells

o What is the function of:
HCl (hydrocholic acid): Kills many organisms, Denatures (unravels) proteins,
Inactivates most enzymes in food, Activates pepsinogen to pepsin, Partially breaks down plant
cell walls and breaks bonds between connective proteins
Pepsinogen/pepsin: digests proteins and pep
Intrinsic factor: absorb Vitamin B12 loss of IF can result in pernicious anemia
Gastrin: stimulate chief and parietal cells; acid production
Mucus: (most abundant) protecting epithelium from acid and other stuff

o What drugs are used to reduce acid production?
antacids
PPI; -prazole(omeprazole) alleviate acid prod
-tidine (cimetidine); H2 receptor antagonist
tums
prilosec
cut vagus

o What occurs in the:
Cephalic phase (know image) stomach ON
prepare stomach for arrival of food
sight, smell, taste, thought of food
short duration (min)
Primary action: increase vol. of gastric juice by stimulating mucus, enzyme, acid
prod.
Secondary action: stimulation of gastrin by G cells
Gastric phase (know image) stomach ON
enhance secretions started in the cephalic stage, homogenize and acidify chyme,
initiate digestion of proteins by pepsin
Duration: long (3-4 hrs)
Mechanisms: Neural (stretch and chemoreceptors), Hormonal (stimulate gastrin
by G cells), Local (release of histamine)
ACTION: increased acid and pepsinogen production, increased motility
MIXING WAVES
Intestinal phase (know image) stomach OFF
control rate of chyme into duodenum
long (hrs)
Mechanisms: Neural, Hormonal (primary & secondary) stimulation of
cholecystokinin (CCK), GIP (Gastric inhibitory pep), and secretin (released by
presence of acid, carbs, and lipids
ACTIONS: feedback inhibition of gastric acid and pepsinogen prod., reduction of
gastric motility

Small intestines:
o What are the three parts? Duodenum, Jejunum, Ileum
o Where does the ampulla of Vater empty into? Duodenum
o Where is the head of the pancreas found? Right side of the abdomen, connected to the
duodenum
o What are plicae (circulares)?
permanent folds of submucosa, to increase surface area
o How does the small intestines increase surface area?
Plica
Villi
Microvilli
o What is the difference between capillaries and lacteals? Where are products transferred to
after they enter either one?
capillaries: carbs and proteins (absorb?)
lacteals: absorb fats (lymph system)
o What are goblets cells and what do they secrete?
mucous cells: secrete mucus

Pancreas:
o What are the two parts? Head and Tail (caudate)
o Endocrine Cells: PIG: Pancreas: insulin, Glucagon
Islets of Langerhan: hormone producing cells ^^^
o Exocrine Cells: PAL (Protease, Amylase, Lipase) ; Protein, carb, lipids
Acini: cell island that produce exocrine cells^^^

Liver:
o Parts? Right and Left Lobes
o Hepatic ducts, common hepatic duct (leaving): Drain bile from liver
Hepatic Artery Proper enters liver (supply oxygenated blood to liver)
Hepatic Portal Vein enters liver (same as artery)
Bile duct: exit (transport bile)
Hepatic vein carries deoxygenated blood to heart
o Portal triad: distinctive arrangement in the liver (triangular shape)
consists of Hepatic Artery Proper, Hepatic Portal Vein, and Bile duct


Gallbladder
o Parts?
Fundus
Body
Neck
o Cystic duct: by the neck of the gallbladder (joins gallbladder with the common bile duct)
and connects with the common hepatic duct (problem: gallstones)
common bile duct: where the common hepatic and cystic duct join; fxn to conduct bile
from gallbladder to duodenum (problem: gallstones choledocholithiasis)
o Function
What 2 ducts empty into the ampulla of Vater (duodenal ampulla)?
1. common bile duct
2. pancreatic duct
What is the function of the sphincter of Oddi (hepatopancreatic sphincter)?
houses the ampulla of Vater, and made up of smooth muscles that contracts to make sure
contents of pancreatic and common bile duct dont enter duodenum. The sphincter
controls flow of bile and pancreatic juices into the duodenum and prevents reflux of
duodenal content into the ducts.

Large intestines:
o Parts:
1. cecum
2. ascending colon
3. transverse colon
4. descending
5. sigmoid
6. rectum
o Function
Its function is to absorb water from the remaining indigestible food matter, and then to
pass useless waste material from the body.

o How is vitamin K produced? by the bacteria in the large intestine
o What valve is found between the small and large intestines? Ileocecal valve
o What is the gastrocolic reflex?
physiological reflexes controlling the motility, or peristalsis, of the
gastrointestinal tract (stimulation is from eating). It involves an increase in
motility of the colon in response to stretch in the stomach and byproducts of
digestion in the small intestine. Thus, this reflex is responsible for the urge to
defecate following a meal. The gastrocolic reflex helps make room for more
food.
Substrates:
o Where does fat digestion begin? mouth and stomach
o Where does carbohydrate digestion begin? mouth
o Where does protein digestion begin? stomach
o Where is fat transported? Capillaries or lacteals? LACTEALS
o Where is protein transported? Capillaries or lacteals? CAPILLARIES
o Where are carbohydrates transported? Capillaries or lacteals? CAPILLARIES
o How are fats digested/broken down? What enzymes or molecules are involved?
utilizes lingual, gastric, pharyngeal, and pancreatic lipases
bile salts (emulsifies lipid drops) micelles formed glycerol and
monoglycerides from micelles diffuse into intestinal epithelia
resynthesize tryglycerides into lymph
fat lacteals lymph thoracic junction b/w left subclavian and left
int. jugular vein heart lungs (bypass liver)
o How are proteins digested? What enzymes or molecules are involved?
digested when pepsinogen is converted to pepsin by HCl
Low pH, pepsin, trypsin, chymotrypsin, elastase
Key to turning on everything is TRYPSIN
following activation by enteropeptidase, trypsin activates other enzymes
o How are carbohydrates or sugars digested? What enzymes or molecules are involved?
digested by salivary and pancreatic amylase
gets hydrolyzed to monosaccharides
o What are amino acids?
organic compounds containing a carboxyl group and amino group
o What are fatty acids?
carboxylic acid
essential fats good for health
result of fats breaking down
o What are monosaccharides?
simple sugar (building blocks)
glucose, fructose, galactose
Disaccharrides?
2 monosacch groups
maltose, sucrose, lactose

Fluids:
o Intake
o Secretion
o Absorption
o Excretion
o Where is most fluid absorbed? JEJUNUM

Acid or base (pH)? Why?
o Mouth: Base
o Esophagus: Base ?
o Stomach: Acid
o Small intestines: Base

Secretions/Functions:
o Amylase
breakdown of starch
o Lipase
breakdown lipids
o Pepsin
breakdown protein/peptides
released in stomach
o HCl (hydrochloric acid)
activate pepsinogen to pepsin
o IF
Absorb Vitamin B12
can result in pernicious anemia if loss of IF
o Mucus
secrete mucus
protect epithelium linings
o Gastrin
stimulates Chief (pepsinogen prod.) and parietal cells (HCl acid, IF)
o Secretin (basic)
brushborder enzymes of the small intestine
stimulate pancreas to secrete digestive fluids rich in bicarbonate; neutralize acids
from the stomach
turn stomach off
increase bile from liver
release HCO3-
o CCK
brushborder enzyme
contracts GB to release bile
relax sphincter of Oddi
release PAL from pancreas
turns stomach off
o GIP (Gastric Inhibitory Polypeptide)
peptide secreted from the stomach that stimulates insulin release and inhibits
pepsin and acid secretion
o Enterokinase
enzyme produced by the mucosa of the small intestine
mainly functions to activate trypsin to trysinogen

o PAL: (breaks internal or external bonds?) EXTERNAL

Trypsin (protease enzyme)
activates all other enzymes in the cascade (turns everything on)
hydrolyzes peptides
Chymotrypsin (protease enzyme)
activate chymotrypsinogen
breakdown peptides
Carboxypeptidase
protease enzyme
breakdown protein/peptides
Elastase
hydrolyzes protein and elastin
Nuclease
breakdown DNA or RNA into their bases
o Bile
emulsifies fat (fat droplets breakup into tiny droplets (micelles)
o HCO3- (bicarbonate)
neutralizes HCl from the stomach

What is cirrhosis? What causes it? What problems may result?
abnormal liver condition in which there is irreversible scarring of the liver.
marked by degeneration of cells, inflammation, and fibrous thickening of tissue.
The main causes are sustained excessive alcohol consumption, viral hepatitis B and C,
and fatty liver disease
People with cirrhosis may develop jaundice (yellowing of the skin, eyes and tongue),
itching and extreme tiredness.

What is cholecystitis?
inflammation of the gallbladder
caused by gallstones (cholesterol and bilirubin in bile)

What is pancreatitis? What causes it? What problems may result?
inflammation of the pancreas
due to pancreatic duct obstruction and/or alcoholic abuse
enzymes get backed up in ducts and activate
can cause vasodilation, increased permeablility, DIC, and circulatory collapse

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Kidney:
Anatomy:
o Review the anatomy of the kidney, ureters, bladder, and urethra
What is the difference between male and female urethras?
-Male (longer)-Both urinary and reproductive functions. Semen and urine pass through.
-Female (Shorter)- Separate from the reproductive organs. Solely Urinary function
What problems are seen?
o What are the 2 major layers of the kidney?
-Renal Cortex
-Renal Medulla
o Where are the kidneys located?
-Retro peritoneal (abdominal cavity behind peritoneal) under diaphragm near back of body.
-Left kidney (T12) is higher than right (L1) due to liver placement
o What vessels supply and remove waste from the kidneys?
-ureter
-bladder
-urethra
-renal artery
-renal vein
o What is the pathway of blood supply to and from the kidneys?

o What is the internal anatomy of the kidneys?

Examples: Renal cortex and medulla, renal pyramid, minor calyx, major calyx, renal
pelvis, hilus, ureter, bladder, urethra, etc.
Glomerulus, Bowmans capsule, proximal convoluted tubules, Loop of Henle (descending
loop, ascending loop), distal convoluted tubule, collecting ducts

o What are the parts of the nephron? What is the flow of fluid through the nephron?
-Renal Corpuscle Proximal Convoluted Tube Loop of Henle Distal Convoluted Tube
Collecting Duct-Pappilary Duct

What part is water permeable?
-Proximal Convoluted Tube
-Descending Limb of loop of Henle

Impermeable?
-ascending limb of Loop of Henle

Dependent on ADH for permeability?
-Distal Convoluted Tube
-Collecting Duct
-TAL (thick ascending limb)

What are the 2 types of nephrons?
Cortical(85%)-Found Superficially in the cortex. Short loop of Henle. Less concentrated urine
Juxtamedullary (15 %)-Found deep in the cortex. Have long loop of Henle. Allow kidneys to
produce concentrated urine (more water you can conserve)

o What is the glomerulus?
-part of renal corpuscle
-filters blood to form urine
What are the 3 layers between the glomerulus and the nephron?
-Endothelium of BV(glomerulus); inside. Protein (albumin), Na+, K+ pass.
-Basal Lamina(glue)-Na+, K+ pass. Negatively Charged (no protein)
-Epithelium (Podocytes)-connected to outside of Bowmans Capsule

o What is the:
Bowmans capsule?
Collects blood filtered by the glomerulus and directs it to the proximal tubule

Visceral (What are podocytes?)
-Podocytes (or visceral epithelial cells) are cells in the Bowman's capsule in the kidneys that
wrap around the capillaries of the glomerulus.

Parietal
parietal layer of Bowmans capsule consists of modified simple squamous epithelium.

PCT/PT?
-absorption of ions, organic molecules, vitamins, and water.

Loop of Henle? Descending, Ascending, thin, thick?
-Descending(thin): permeable to water
-Ascending(thin): impermeable to water. Permeable to ions-Na+ and K+
-Ascending (thick)-reabsorbs sodium, potassium, and chloride ions from the filtrate

DCT?
-secretion: ions, acids, drugs, toxins
-variable reabsorption of water, Na+, CL- (with the induction of ADH)

Collecting ducts?
-variable reabsorption of water (with induction of ADH)
-reabsorption or secretion of Na+, K+, H+, and bicarbonate ions

o What is the juxtaglomerular apparatus (macula densa, juxtaglomerular cells)?
-Function: maintains BP, NA+, and H20 with renin
*** if urine is clear and good, you can pee renin out
-Juxtamedullary Cells (Responders):secrete renin and regulates GFR
-Macula Densa: monitors osmolarity in DCT

Physiology:
o What is the basic functional unit of the kidney?
-nephron
o What is ADH? What does it do? Where does it affect?
-ADH causes the DCT and collecting ducts to be permeable to water, increasing water
reabsorption and reducing urine output
-released in response to low blood volume, high osmolarity, and AII
1) conserve H20
2) Thirst
3) vasoconstrict
o What is aldosterone? What does it do? Where does it affect?
-steroid hormone produced in the zona glomerulosa of adrenal cortex
-released in response to AII (increase BP) and high plasma potassium
-Stimulates sodium potassium pump (increased reabsorption of sodium and increase secretion of
pottasium)
-also increases retention of sodium and water and loss of potassium
-targets distal tubules and collecting ducts

o What is RAAS? What and where are these hormones converted?
-hormone system that regulates blood pressure and water (fluid) balance.
-Renin: enzyme released from macula densa cells in response to low BP or sodium. ACtivates
angiotensinogen to angiotensin I (AI)
-Angiotensinogen: produced as the precursor to angiotensin in the liver, activated to AI by renin
and converted to AII by ACE(angiotensin converting enzyme)
-AII : 1) brain induces thirst (ADH)
2) Adrenal cortex to release aldosterone
3) vasoconstrict (increase resistance and BP)

o What are the major functions of the kidney? (Remember: acid-base balance and
osmolarity?)
-eliminating metabolic waste products (example: urea)
-conserving nutrients (as much as possible)
-balancing output with input of water and electrolytes
-Regulation of Blood Volume and Blood Pressure
-Regulation of plasma pH
-Participates in amino acid catabolism

o How does the nephron (kidney) regulate osmolarity? AKA: What are the 3 active
functions of the nephron?
1) Filtration of solid wastes in the blood
2) Reabsorption of essential nutrients from the fluid before it becomes urine
3) Excretion of urine as body waste.

What is the passive result of these 3 functions?
o What is Starlings law of the capillaries? (Jv = Kf [(Pc Pi) s(pc - pi)] )
o FILTRATION:
o What is GFR? What is the average GFR per minute?
-GFR=filtration
-125 ml/min
What is the afferent arteriole and efferent arteriole?
-afferent arteriole: each supplies a renal corpuscle to form the capillary network (glomerulus)
(glomerular filtrate formed here)
-efferent arteriole: blood leaves the glomerulus through this arteriole
How is GFR affected by changes in the afferent and efferent arterioles?What happens to
GFR when the diameter of the...
Aff. art. is
o Increased? increase filtration
o Decreased? decrease filtration
Eff. art. is
o Increased? decrease filtration
o Decreased? increase filtration
What does Angiotensin II do to the aff and eff arterioles?
-efferent: constricts (more)
-afferent: constricts
What does ANP do to filtration?
-increases filtration
o What else does ANP do?
-inhibits reabsorption of sodium causing natriuresis ( increase urine output)
o What triggers its release?
- small peptide hormones produced in the heart
-released due to stretch or injury of atrial or ventricular myocytes (muscle cells)
o What is renal autoregulation?
-kidneys themselves help maintain a constant renal blood flow and GFR despite normal,
everyday changes in blood pressure
What is the myogenic mechanism?
-how arteries and arterioles react to an increase or decrease of blood pressure to keep the blood
flow within the blood vessel constant.
What is tubuloglomerular feedback?
-principle mechanism responsible for renal autoregulation
-helps maintain a stable GFR
-utilizes JGA(responder) and macula densa (sensor)
o What is the JGA? Macula densa?
JGA=Responder
Macula Densa=Sensor
What does the JGA and macula densa do?
Macula densa= monitors osmolarity of DCT
JGA=secretes renin
What does the macula densa measure in the nephron?
-osmolarity of DCT (concentration of solution)
What hormone is released from the JGA?
-Renin

o REABSORPTION AND SECRETION:
What part of the nephron reabsorbs the most (60-70%) solutes and fluid?
-Proximal Convoluted Tube
What does the Na+ symporter cotransport?( AKA: what does Na+ bring into the body with
it? )
-H20, K+, CL-, Glucose (I think its just water?) -Mirie
What does the Na+/H+ antiporter countertransport?
What occurs in the descending loop (of Henle)? Is it water permeable?
-reabsorption of water
What occurs in the thin ascending loop? Is it water permeable?
-reabsorption of Na+ and CL-
-impermeable to water
What occurs in the thick ascending loop? Is it water permeable?
-reabsorption of Na+, Cl-
-in exchange of K+ (sodium pottasium pump)
-impermeable to water

What symporter is found there?
-Na-K-Cl cotransporter is located there (NA/k pump)
How does this create the different layers of osmolarity in the kidney?
-the regulation of
What occurs in the distal convoluted tubule (DCT)?
--secretion: ions, acids, drugs, toxins
-variable reabsorption of water, Na+, CL- (with the induction of ADH)

What symporters are found in the apical membrane?
-Sodium Chloride Symporter (NaCL co-transporter)

What occurs in the collecting duct (CD)?
--variable reabsorption of water (with induction of ADH)
-reabsorption or secretion of Na+, K+, H+, and bicarbonate ions

What are principal cells?
-predominantly responsible for sodium reabsorption and potassium secretion in the kidney

What are intercalated cells?
-intercalated cells-secrete acid and reabsorb bicarbonate
-intercalated cells-secrete bicarbonate and reabsorb acid

Where do potassium (K+) sparing diuretics work?
-furosemide: thick ascending limb
-thiazide: distal convoluted tubule

o What is the Renin-Angiotensin-Aldosterone System? (RAAS)
--is a hormone system that regulates blood pressure and water (fluid) balance.
-Renin: enzyme released from macula densa cells in respose to low BP or sodium. ACtivates
angiotensinogen to angiotensin I (AI)
-Angiotensin: produced as the precursor angiotensinogen in the liver, activated to AI by renin
and converted to AII by ACE(angiotensin converting enzyme)
-AII is a potent vasoconstrictor, elicits thirst, and causes release of ADH and Aldosterone

Where is angiotensinogen made?
- liver
Where is it converted to angiotensin-I (AI)? What enzyme does this?
-Renin (kidneys) + Angiotensinogen (liver) = Angiotensin I
-renin is the enzyme
Where is it converted to angiotensin-II (AII)? What enzyme does this?
Angiotensin I + Angiotensin Converting Enzyme Con (lungs) = Angiotensin II
What does AII do?
-AII is a potent vasoconstrictor, elicits thirst, and causes release of ADH and Aldosterone
Where does it work?
o Brain (posterior pituitary)
-Causes release of ADH from posterior pituitary
o Adrenal cortex
-Causes release of aldosterone from adrenal cortex
What does aldosterone do?
-causes the principal cells of the distal nephron to increase reabsorp-tion of sodium and
increase secretion of potassium.
o Blood vessels (afferent and efferent arterioles)
-AII causes vasoconstriction of arteriols (specifically efferent arteriols)
o What is ADH (antidiuretic hormone)?
-A small peptide hormone produced in the hypothalamus and then stored and released
from the posterior pituitary in response to low blood volume, high osmolarity, and AII
o What is ANP (atrial netriuretic peptide)?
-Small peptide hormones produced in the atria and released in response to stretch or
injury of atrial (muscle cells)
-inhibits the reabsorption of sodium causing natriuresis (increased urine output due to
increase of sodium output)

o What are diuretics?
-causing direct increase in the passing of urine

What is renal plasma clearance?
-volume of plasma completely cleared of a specific compound per unit time
-used to measure kidney function
What is dialysis?
-the filtering of circulating blood through a semipermeable membrane in an apparatus
(haemodialyser or artificial kidney) to remove waste products: performed in cases of kidney
failure.

Fluid, Electrolyte, and Acid-Base Balance
What are the different fluid compartments?
-intracellular: fluid found within body cells plasma membrane
-Extracellular: body fluid outside of cells
*interstitial compartment: the space that surrounds the cells of a given tissue. Filled with
interstitial fluid
*plasma: extracellular portion of the blood
*transcellular compartment: fluid outside normal compartments (CSF, Digestive juices,
Mucous)
o What are the percentages of fluid found in each compartment?
60-40-20-16-4
Intracellular-60%
Extracellular-40%
-interstitial compartment: 20%
-plasma:16%
-transcellular: 4%
o What are the electrolytes of the body?
Na+
Cl-
K+
HCO3-
Ca++
PO
4
3-
Mg++
Etc
o What electrolytes have a higher concentration inside the cell? Outside the cell?
-inside: PO
4
3-, K+, Mg++
-outside: Na+, Cl-, HCo3-, Ca++
o What are fluid shifts? What happens with hemorrhage? Diarrhea? Sweating in a desert?
Eating too much NaCl (salt)? SIADH? Renal insufficiency?
-fluid shifts: when bodily fluid moves between compartments.
*hemorrhage: escapement of blood from a ruptured blood vessel
*Diarrhea: usually occurs when fluid cannot be absorbed from the contents of your
bowel, or when extra fluid is secreted into your bowel, causing watery faeces.
*Eating too much salt: too much salt = increase in bodily fluids (edema)
*Sweating in desert-fluid loss from cells
*SIADH-sodium remains normal but excessive retention of water
What is acidosis? pH?
-Physiological pH less than 7.35
What is alkalosis? pH?
-Physiological pH greater than 7.45
How does the kidney handle acid-base balance?
-Controls excretion/reabsorbtion of H+ and HCO
3
-
from renal tubules
What is respiratory acidosis?
o Definition: Abnormally high PCO
2
in systemic blood above 45 mmHg.
o What is the cause? Hypoventilation
o What is the compensation?
Hyperventilation

What is respiratory alkalosis?
o Definition: Abnormally low
systemic PCO
2
bellow 35 mmHg.
o What is the cause? Hyperventilation
o What is the compensation?
Hypoventilation

What is metabolic acidosis?
o Definition: low plasma pH
o What is the cause?
-increase in H+ production
-decrease H+ excretion
-Decrease HCO3- production
-increase HCO3- excretion
o What is the compensation?
-Respiratory compensation:
hyperventilation
-Renal compensation: H+ ions secreted and
HCO3- reabsorbed
What is metabolic alkalosis?
o Definition: High plasma pH
o What is the cause?
-decrease H+ production
-increase H+ secretion
-increase HCO3- production
-decrease HCO3- excretion
o What is the compensation?
-Respiratory compensation: hypoventilation
-Renal Compensation: H+ ions reabsorbed
and HCO3- secreted

How do the lungs regulate CO2? How does the kidney trap acid? Control or regulate base
(HCO3-)?
-Lungs regulate CO2 by controlling breathing rate. Hyperventilation reduces PCO2 and
hypoventilation increase PCO2.
-Kidneys trap acid by keeping the particles charged
-the kidneys will regulate pH through the reabsorption of of HCO3-. Reabsorption of HCO3-
predominantly occurs in the proximal convoluted tubule


Nutrition and Metabolism:
Metabolism?
-refers to all chemical reactions in an organism
Catabolism?
- breakdown of organic substrates
-releases energy used to synthesize high energy compounds (ex ATP)
Anabolism?
-synthesis of new organic molecules
How is ATP regenerated?

Creatine phosphate (immediate source of ATP)
-ATP-----ADP + P + energy release
-regeneration: ADP + P-----ATP (substrate level phosphorylation)

Glycolysis
-breaks 6-carbon glucose
-into two 3-carbon pyruvic acid
-investment of 2 ATP, 6 carbon glucose, 2 ATP, 2 NAD, 4 ADP, 2 Pi
-Product: 2, 3 carbon pyruvate, 4 ATP (net 2 ATP), 2 NADH

TCA
-function: to remove hydrogen atoms from organic molecules and transfer them to coenzymes
-Pyruvate is oxidized and decarboxylated------> Acetyl-Coa
-Acetyl-Coa to oxaloacetic acid----->citric acid--->isocitric acid---->alpha-ketoglutarate----
>succinal-Coa---->Succinic acid--->fumeric acid---->malic acid---->oxaloacetic acid ----> repeat
-Products per 2 molecules of pyruvate = 8 NADH, 2 FADH, 2 CO2, 2 GTP

ETC
-generation of ATP within inner mitochondrial membrane
-key is oxidative phosphorylation
-Coenzymes (NADH and FADH) drop off electrons
-transfer of electrons creates gradient causing H+ ions to diffuse through membrane
-H+ ions return through ATP synthase, thus catalyzing the reaction of ADP+P---> ATP
-NADH=3 ATP
-FADH=2 ATP
-28 from ETS (32 if including NADH from glycolysis)
-36 ATP total
What is:
Oxidative phosphorylation?
Is the generation of ATP within mitochondria in a reaction requiring coenzymes and oxygen
-produces more than 90% of ATP used by body

Carbohydrate (glucose) metabolism:
o Catabolism:
- breakdown of organic substrates
-releases energy used to synthesize high energy compounds (ex ATP)
How many ATP are generated per glucose molecule in glycolysis? TCA (or Krebs) cycle?
ETC (eletron transport chain)?
Glycolysis = 2 net ATP
TCA=2 GTP
Kreb = 28 ATP (from TCA) + 4 ATP (from NADH generated in glycolysis)
Total = 36 ATP (32 from ETC, 2 from kreb, 2 from glyocolysis)
How many steps are involved in glycolysis?
1) As soon as a glucose molecule enters the cytoplasm, a phosphate group is attached to the
molecule
2) A second phosphate group is attached. Together, steps 1 and 2 cost the cell 2 ATP
3) The 6 carbon chain is split into 3 carbon molecules, each of which then follows the rest of this
pathway
4) Another phosphate group is attached to each molecule, and NADH is generated from NAD
5) One ATP molecule is formed for each molecule processed (2 ATP produced)
6) The atoms in each molecule are rearranged, releasing a molecule of water
7) A second ATP molecule is formed for each molecule processed. Step 7 produces 2 ATP
molecules
At what steps of the glycolytic cycle is ATP used up? Generated? Total?
-2 ATP used in steps 1 and 2
- 2 ATP gained in step 5 and step 7 (4 total)
What is the final electron acceptor? O2
What are the steps in the TCA (or Krebs) cycle?
From citrate to _isocitrate____ to _alpha-ketogluterate_____ to _succinal-coa_____ to
_succinic acid____ to _fumeric acid_____ to _malic acid____ to _oxeloacetic acid___
What product from glycolysis goes into the TCA cycle? What does it go in as?
-Pyruvate (2)-----> Acetyl-Coa (2)
How is ATP generated in the electron transport chain? 28 ATP (TCA) + 4 ATP (NADH
produced in glycolysis) = 32 total
What is NADH? NAD+? Which carries electrons (via H+ or hydrogens) to the electron
transport chain to generate ATP in aerobic respiration?
-NAD+=Nicotinamide adenine dinucleotide
-NAD+ = coenzyme responsible for picking up a hydrogen ion
-NADH = coenzyme carrier that brings H+ to ETC
Where does NADH + H+ come from? (hint: what pathways)
-Glycolysis and intermediate
What is FADH2? FAD? Which carries electrons (via H+ or hydrogens) to the electron
transport chain to generate ATP in aerobic respiration?
FAD+=Riboflavin Adenine Dinucleotide
FAD+=coenzyme responsible for picking up
FADH2=coenzyme carrier that brings H+ to ETC
Where does FADH2 come from? (hint: what pathways)
-TCA cycle
How is unused glucose stored? Where is most of this product stored?
-unused glucose is stored as glycogen in liver and skeletal muscle
What is glycogenesis?
-synthesis of glygogen
-----------------------------------------------------------------------------------------------------------------
o Anabolism: is the synthesis of new organic molecules
What is glycogenesis?
- the formation of glycogen from glucose. (Occurs slowly; requires high energy compound
uridine triphosphate UTP)
What hormone is involved? (Hint: take glucose IN to the cells)
What is the difference between skeletal muscle cell glycogen and liver glycogen? Which
can be converted to glucose and released into the bloodstream? (HINT: skeletal muscle glycogen
is used up and the byproduct of lactic acid is sent to the liver for conversion [via Coris cycle]
into glucose)
-
What is glycogenolysis?
- is the breakdown of glycogen (occurs quickly; involves a single enzymatic step)
Glucose-1-phosphate to glucose-6-phosphate to glucose
What hormone is involved? (Hint: when blood glucose is GONE)
- glucagon??
What is Gluconeogenesis?
- is the synthesis of glucose from non-carbohydrate precursors
What 2 hormones stimulate gluconeogenesis?
- glucagon and epinephrine??
Lipid metabolism:
o What are the 4 classes of lipoproteins? (GO THROUGH THE PATHWAYS)
- There are 5 classes
Chylomicrons
- produced in the intestinal tract
- are too large to diffuse across capillary wall
- enter lymphatic capillaries
- travel through THORACIC DUCT (to venous circulation and systemic arteries)
VLDLs: Very low-density lipoproteins
(IDLs): intermediate-density lipoproteins
- b/w LDLs and VLDLs
LDLs: Low-density lipoproteins
- bad
- take to fat cells, storage
HDLs: High-density lipoproteins
- good
- clean out bloodstream take back to liver and 1) turn into bile, or 2) return to body
What is the difference between each?
-
Which form has a higher amount of protein than the others and is capable of removing
excess cholesterol from boy cells and the blood (to transport to the liver for elimination)?
- HDL (High-density lipoproteins)
After lipids are transported across the GI tract (as micelles and chylomicrons) how they
are transported to the liver? How are lipids transported in the blood?
- Intestinal tract Lacteals Thoracic Duct Circulatory system Capillaries liver cells
Apoproteins (Apo)
What are the 2 essential fatty acids that the body cannot synthesize?
- linolenic and linoleic acid cannot be synthesized in the body and must be obtained from food;
these basic fats are used to build specialized fats called omega-3 and omega-6 fatty acids
What does adipose tissue remove from chylomicrons and VLDLs?
-
o What is lipolysis? What enzymes do this function?
- Lipolysis AKA lipid catabolism breaks lipids down into pieces that can be 1) converted to
pyruvic acid, or 2) channeled directly into TCA Cycle
-
What is beta oxidation?
- A series of reactions
- Breaks fatty acid molecules into 2-Carbon fragments
- Occurs inside mitochondria
- Each step, 1) generates molecules of Acetyl CoA and NADH, and 2) leaves a shorter carbon
chain bound to coenzyme A
o What is lipogenesis? When does this occur?
- Lipogenesis AKA Lipid synthesis can use almost any organic substrate because lipids, amino
acids, and carbohydrates can be converted to acetyl-CoA
-
What is ketosis?
- a condition characterized by raised levels of ketone bodies in the body, associated with
abnormal fat metabolism and diabetes mellitus.
- ketone body: any of three relates compounds (acetone, acetoacetic acid, beta-hydroxybutyric
acid) produced during the metabolism of fats.
Protein metabolism:
o What is the end product of protein metabolism? (hint: ammonium)
- ammonium ions converted to urea
o What is ammonium converted to in the urea cycle?
- urea
o How are these excreted from the body?
- in urine
What are the fat soluble vitamins?
- A, D, E, K
Reproductive: Male:
Anatomy:
o Review the anatomy of the male:
o Internal:
Testes, epididymis, vas deferens, ejaculatory duct, urethra, seminal vesicle, prostate,
bulbourethral glands, etc.
o External genitalia:
Penis, corpus sponsiosum, corpora cavernosum, pampiniform plexus, testicular artery,
scrotal sac, cremaster muscle, etc.
o What structure produces sperm?
- seminiferous tubules
o Where does sperm mature?
- epididymis
o Where is non-viable sperm reabsorbed?
- epididymis
o What are stereocilia?
- The stereocilia are long cytoplasmic projections that act more like microvilli than cilia at all.
They increase the surface area to greater exhibit secretion and absorption of the cell. Unlike
true cilia, they have no microtubules, which means they are non-motile. From the stereocilia,
large amounts of fluid are secreted to propel the spermatozoa. In turn, the stereocilia will then
reabsorb around 90% of that same fluid.
o What are the 3 parts of the urethra?
- 1) prostatic 2) membranous 3) penile/spongy
o What are the accessory glands?
- 1) Prostate gland 2) Cowpers (Bulbourethral glands) 3) Seminal vesicles
o What are the 2 cells that assist in growth and maturation of the spermatogonia?
- Sustentacular (Sertoli) cells and Interstitial (Leydig) cells
o What are Sertoli cells also called?
- Sustentacular cells (respond to FSH)
o What are Leydig cells also called?
- Interstitial cells (respond to LH)
o How do the testes get to the outside of the body? When does this occur?
- Movement of testes through inguinal canal into scrotum and testes remain connected to internal
structures via the spermatic cords
- Occurs during fetal development
o What is the potential space that internal organs such as the GI tract can pass through?
What is this problem called?
- inguinal canal
- hernia: when a structure thats not supposed to be there, pushed through
o What is the anatomy of the spermatozoon?
- 1) Head: nucleus and densely packed chromosomes 2) Middle piece: mitochondria that produce
the ATP needed to move the tail 3) Tail: the only flagellum in the human body
Physiology:
o What occurs in the seminiferous tubules?
- the production of sperm, contain spermatogonia: stem cells involved in spermatogenesis
o What cells are present?
- Sustentacular cells (Sertoli) and Interstitial cells (Leydig)
o What is spermatogenesis?
- 1) Mitosis 2) Meiosis (I & II)
o What is spermiogenesis?
- maturation of secondary spermatocytes
o What is mitosis? Meiosis? What are the phases?

o What are the stages of sperm development in meiosis?
- refer to above picture
How is it different from oogenesis (female egg development)?
- Spermatogenesis: after the two meiotic divisions in a single spermatogonium, there are 4
spermatids which then go on to form 4 sperm cells or spermatozoa.
- Oogenesis: after the two meiotic divisions in a single oogonium, you get one ovum and 3 polar
bodies. Each time the oocyte divides, most of the cytoplasm goes into one product and the other
one (the polar body) just gets a set of chromosomes.
o What is the function of Sertoli cells?
- Helps to control the composition of the jelly surrounding the spermatids (help w/nourishment
of sperm)
o What is the function of Leydig cells?
- They produce testosterone, which is essential to spermatogenesis. (matures and helps sperm
grow)
o Hormones:
GnRH (Gonadotropin Releasing Hormone)
FSH (Follicle Stimulating Hormone)
LH (Leutinizing Hormone)
Testosterone
Inhibin
What hormones are secreted from the hypothalamus and anterior pituitary that act on the
male gonads?
- Hypothalamus: releases GnRH Anterior Pituitary: releases LH and FSH
o What hormones regulate the male gonads and sperm production?
- FSH and LH
What is their target organ and what is their function?

o Accessory glands:
What does the seminal vesicle secrete?
- seminal fluid: a distinct ionic and nutritive glandular secretion
- contributes 60% total volume of semen
- secretions contain fructose, prostaglandins, and fibrinogen
What do these products do?
What does the prostate gland secrete?
- slightly acidic prostate fluid
What do these products do?
What does the bulbourethral gland secrete?
- Secrete alkaline mucus with lubricating properties
What do these products do?
o What is negative feedback and how does it affect this system?
- Sustentacular cells secrete inhibin which then inhibits secretion of FSH. It could also feed
back to the hypothalamus inhibiting the secretion of GnRH inhibition of LH & FSH
- If there is too much testosterone being produced, inhibin could signal to the hypothalamus to
stop the production of GnRH which would then stop the production of LH and FSH. (Refer to
above picture)

Reproductive: Female:
Anatomy:
o Review the anatomy of the female:
Internal:
Ovaries, fallopian tubes, uterus, cervix, vagina, etc.
External:
Vagina, labia major, labia minor, mons pubis, vestibule, clitoris, etc.
o What structure produces eggs?
- Ovaries (ovarian follicles)
o Where do eggs mature?
- Ovaries
o What is the follicle?
- egg and nest
o What is the corpus luteum?
- yellow body; a hormone secreting structure that develops in an ovary after an ovum has been
discharged but degenerates after a few days unless pregnancy has begun
o What is the corpus albicans?
- white body; the regressed form of the corpus luteum. As the corpus luteum is being broken
down by macrophages, fibroblasts lay down type I collagen forming the corpus albicans
o What are the 2 cells that assist in growth and maturation of the egg?
- Granulosa & Theca cells
o What are Granulosa cells?
- Granulosa cells make estrogen from androgens by Theca cells
o What are Theca cells?
- Theca cells make androgen
o What are the different supporting ligaments?
- 1) broad ligament 2) 3 pairs of suspensory ligaments 3) ovarian ligament

o Major anatomical landmarks of the uterus
Body
Isthmus
Cervix
Cervical os (internal orifice)
Uterine cavity
Cervical canal
Internal os (internal orifice)
Uterine wall: myometrium, endometrium, perimetrium
Physiology:
o What is oogenesis?
- ovum production, occurs monthly in ovarian follicles, part of OVARIAN cycle (Follicular
phase: preovulatory, Luteal phase: postovulatory)
What stages are halted (frozen) and when does this occur?
- Meiosis I: (Prophase I: completed after puberty) AND Meiosis II: (Metaphase II: completed
after fertilization)
o What is mitosis? Meiosis?
- Mitosis: a type of cell division that results in two daughter cells each having the same number
and kind of chromosomes as the parent nucleus.
- Meiosis: a type of cell division that results in 4 daughter cells each with half the number of
chromosomes of the parent cell, as in the production of gametes.
o What are the 2 cycles for the female?
- 1) Uterine cycle 2) Ovarian cycle
What occurs during the uterine cycle?
- (0-5: Menses) Proliferative phase: Estrogen Estrogen Peak LH Surge (14)
Ovulation: release of egg from ovaries Secretory phase: Progesterone
What are the phases?
o Menses (1)
o Proliferative (2)
o Ovulation (3)
o Secretory (4)
What occurs during the ovarian cycle?
- Hypothalamus: GnRH Anterior pituitary: FSH Follicular phase: estrogen Estrogen
peak LH surge Ovulation Corpus luteum Luteal phase: progesterone (to fluff)
What are the phases?
o Follicular phase
o Ovulation
o Luteal phase
o Hormones:
GnRH
FSH
LH
Estrogen
Androgens
Progesterone (progestins)
hCG
What hormones are secreted from the hypothalamus and anterior pituitary that act on the
female gonads?
- Hypothalamus: GnRH
Anterior Pituitary: FSH & LH
What hormones are secreted from the ovaries before and after ovulation?
- before: estrogen (proliferative phase & follicular phase), LH (LH surge)
- after: progesterone (luteal phase & secretory phase)
What hormones act on the uterus during the different phases of the uterine cycle?
- Estrogen, LH and progesterone
o Where does fertilization most commonly take place?
- in the fallopian tubes AKA the uterine tubes
o Cells:
What is the function of Granulosa cells?
- to make estrogen (from Theca cells)
What is the function of Theca cells?
- to make angrodens (used in making estrogen)
What happens after ovulation to these cells?
- They form the corpus luteum
o Adrenal cortex pathway: remember the diagram from before?
o What hormone acts on the granulosa cell?
- FSH
What does this cell make (or convert)?
- makes Estrogen from androgen (by theca cells)
o What hormone acts on the thecal cell?
- LH
o After ovulation these 2 cells combine to form corpus luteum, which begins to secrete
(produce) progesterone and estrogen.