Answers for terms of medical physiology

Textbook of Medical Physiology (Guyton & Hall, tenth edition)

1.

Internal environment

In the extracellular fluid are the ions and nutrients needed by the cells for maintenance of cellular life. Therefore, all cells live in essentially the same environment, the extracellular fluid, for which reason the extracellular fluid is called the internal environment of the body. 2. Homeostasis

Homeostasis is the term used by physiologists to mean maintenance of static or constant conditions in the internal environment. 3. Negative feedback

Negative feedback is a type of feedback, during which a system responds so as to reverse the direction of change. Since this process tends to keep things constant, it is stabilizing and attempts to maintain homeostasis. 4. Positive feedback

Positive feedback is a type of feedback. In the case of positive feedback the response of the system is to change that variable even more in the same direction. This has a de-stabilizing effect, so left unchecked, does not result in homeostasis. 5. Channel proteins

The protein channels are watery pathways through the interstices of the protein molecules. Substances can diffuse by simple diffusion directly through these channels from one side of the membrane to the other. The protein channels are distinguished by two important characteristics: (1) they are often selectively permeable to certain substances and (2) many of the channels can be opened or closed by gates. 6. Voltage gating

Some protein channel gates respond to the electrical potential across the cell membrane, this causes a conformational change in the protein molecule that opens or closes the gate. This is called Voltage gating. 7. Ligand gating

Some protein channel gates are opened by the binding of a chemical substance (a ligand) with the protein, this causes a conformational change in the protein molecule that opens or closes the gate. This is called chemical gating or ligand gating. 8. Primary active transport and secondary active transport

When a cell membrane moves molecules or ions uphill against a concentration gradient (or uphill against an electrical or pressure gradient), the process is called active transport. Active transport is divided into two types according to the source of the energy used to cause the transport. They are called primary active transport and secondary active transport. In primary active transport, the energy is derived directly from breakdown of adenosine triphosphate (ATP) or of some other high-energy phosphate compound. In secondary active transport, the energy is derived secondarily from energy that has been stored in the form of ionic concentration differences between the two sides of a membrane, created in the first place by primary active transport. 9. Co-transport and counter-transport

When sodium ions are transported out of cells by primary active transport, a large concentration gradient of sodium usually develops very high concentration outside the cell and very low concentration inside. This gradient represents a storehouse of energy because the excess sodium outside the cell membrane is always attempting to diffuse to the interior. Under appropriate conditions, this diffusion energy of sodium literally can pull other substances along with the sodium through the cell membrane. This phenomenon is called cotransport. Under other conditions, sodium ions attempt to diffuse to the interior of the cell when the other substance to be transported is on the inside of the cell and must be transported to the outside. This is called counter-transport. Co-transport and counter-transport are two forms of secondary active transport. 10. Resting potential The resting potential is the transmembrane potential difference across the membrane of a normal cell at rest. Resting potential of cells is typically in the range of -10 to -100 mV, the inside of the cell being negative with respect to the outside. 11. Action potential Some of the cells (excitable cells) are capable to rapidly reverse their resting potential from negative resting values to slightly positive values. This transient and rapid change in membrane potential is called an action potential. 12. Threshold potential

A sudden rise in membrane potential of 15 to 30 millivolts usually is required to initiate an action potential. The threshold potential is the membrane potential to which a membrane must be depolarized to initiate an action potential. 13. All-or-nothing principle . Once an action potential has been elicited at any point on the membrane of a normal fiber, the depolarization process travels over the entire membrane if conditions are right, or it might not travel at all if conditions are not right. This is called the all-or-nothing principle. 14. Cross-bridge The tails of the myosin molecules bundled together to form the body of the filament, while many heads of the molecules hang outward to the sides of the body. Also, part of each myosin molecule hangs to the side along with the head, thus providing an arm that extends the head outward from the body. The protruding arms and heads together are called cross-bridges. One feature of the cross-bridges essential for muscle contraction is that it functions as an ATPase enzyme. And another feature is that it is also an actin binding site. 15. Absolute refractory period That period immediately following the discharge of an action potential during which the cell cannot be induced to fire again. 16. End plate potential Upon the arrival of an action potential at the axon terminal, acetylcholine releases and binds to the nicotinic acetycholine receptors that dot the motor end plate. Thus opening of acetylcholinegated channels is to allow large numbers of sodium ions to pour to the inside of the fiber, carrying with them large numbers of positive charges. This creates a local positive potential change inside the muscle fiber membrane called the end plate potential. In turn, this end plate potential initiates an action potential spreading along the muscle membrane and thus causes muscle contraction. 17. Excitation-contraction coupling To cause muscle contraction, electrical currents must penetrate deeply into the muscle fiber to the vicinity of all the separate myofibrils. This is achieved by transmission of action potentials along transverse tubules (T tubules) that penetrate all the way through the muscle fiber from one side to the other. The T tubule action potentials in turn cause release of calcium ions in the immediate vicinity of all the myofibrils, and these calcium ions then cause contraction. This overall process is called excitation-contraction coupling. 18. Active tension

The increase in tension that occurs during contraction, called active tension, decreases as the muscle is stretched beyond its normal length-that is, to a sarcomere length greater than about 2.2 micrometers. 19. Isometric contraction & isotonic contraction Muscle contraction is said to be isometric when the muscle does not shorten during contraction and isotonic when it does shorten with the tension on the muscle remaining constant. 20. Hematocrit The hematocrit is the fraction of the blood composed of red blood cells, as determined by centrifuging blood in a hematocrit tube until the cells become tightly packed in the bottom of the tube. In men, the measured hemtocrit is normally about 0.40, and in women, it is about 0.36. 21. Colloid osmotic pressure In normal plasma, the plasma proteins are the major colloids present. The component of the total osmotic pressure due to the colloids is known as colloid osmotic pressure. 22. Erythrocyte sedimentation rate The rate at which erythrocytes settle out of unclotted blood in one hour is called e rythrocyte sedimentation rate. 23. Erythropoietin Erythropoietin (EPO), a glycoprotein hormone produced primarily by cells of the peritubular capillary endothelium of the kidney, is responsible for the regulation of red blood cell mainly in low oxygen states. 24. Hemostasis The term hemostasis means prevention of blood loss. Whenever a vessel is severed or ruptured. Hemostasis is achieved by several mechanisms: (1) vascular spasm, (2) formation of a platelet plug, (3) formation of a blood clot as a result of blood coagulation, and (4) eventual growth of fibrous tissue into the blood clot to close the hole in the vessel permanently. 25. Blood coagulation Blood coagulation is a process that changes circulating substances within the blood into an insoluble gel. It takes place in three essential steps: (1) Formation of a complex of activated substances collectively called prothrombin activator. (2) The prothrombin activator catalyzes the conversion of prothrombin into thrombin. (3) The thrombin acts as an enzyme to convert

fibrinogen into fibrin fibers that enmesh platelets, blood cells, and plasma to form the clot. 26. Antithrombin III Antithrombin, an alpha-globulin, is a potent inhibitor of the coagulation cascade. It is a non vitamin K-dependent protease that inhibits the action of thrombin as well as other procoagulant factors (eg, factor Xa). 27. Blood typing Before giving a transfusion to a person, it is necessary to determine the blood type of the recipients blood and the blood type of the donor blood so that the bloods can be appropriately matched. This is called blood typing, and it is performed in the following way: The red blood cells are first separated from the plasma and diluted with saline. One portion is then mixed with anti-A agglutinin and another portion with anti-B agglutinin. After several minutes, the mixtures are observed under a microscope. If the red blood cells have become clumped that is, agglutinatedone knows that an antibodyantigen reaction has resulted. 28. Premature systole A premature contraction of the heart, resulting in momentary cardiac arrhythmia, is called premature systole. 29. Cardiac cycle The cardiac events that occur from the beginning of one heartbeat to the beginning of the next are called the cardiac cycle. The cardiac cycle consists of a period of relaxation called diastole, during which the heart fills with blood, followed by a period of contraction called systole. 30. Stroke volume output Stroke volume output is the volume of blood ejected from the left ventricle each beat. In adults, the normal value of stroke volume output for the resting adult is 60~80ml. 31. Cardiac output Cardiac output is the total volume of blood pumped by the ventricle per minute, or simply the product of heart rate (HR) and stroke volume (SV). The average cardiac output for the resting adult is about 5L/min. 32. Ejection fraction The percentage of blood that is pumped out of a filled ventricle as a result of a heartbeat is called ejection fraction.

33. Cardiac index Cardiac index is the cardiac output per square meter of body surface area. The normal human being weighing 70 kilograms has a body surface area of about 1.7 square meters, which means that the normal average cardiac index for adults is about 3 L/min/m2 of body surface area. 34. Cardiac reserve Cardiac reserve refers to the heart's ability to quickly adjust to immediate demands placed upon it. The maximum percentage that the cardiac output can increase above normal is called the cardiac reserve. In the normal young adult the cardiac reserve is 300 to 400 percent. 35. Frank-Starling mechanism The heart has the intrinsic capability of increasing its force of contraction and therefore stroke volume in response to an increase in venous return. This is called the Frank-Starling mechanism in honor of the scientific contributions of Otto Frank (late 19 th century) and Ernest Starling (early 20th century). This phenomenon occurs in isolated hearts, and therefore is independent of neural and humoral influences. 36. Atrioventricular delay The conductive system is organized so that the cardiac impulse does not travel from the atria into the ventricles too rapidly. It is primarily the A-V node and its adjacent conductive fibers that delay this transmission of the cardiac impulse from the atria into the ventricles. This delay allows time for the atria to empty their blood into the ventricles before ventricular contraction begins. 37. Electrocardiogram When the cardiac impulse passes through the heart, electrical current also spreads from the heart into the adjacent tissues surrounding the heart. A small proportion of the current spreads all the way to the surface of the body. If electrodes are placed on the body skin on opposite sides of the heart, electrical potentials generated by the current can be recorded; the recording is known as an electrocardiogram. 38. Einthovens triangle The primary leads I, II and III are often regarded as forming an equilateral triangle in the center of the chest called Einthovens triangle. The vector sum of all cardiac activity is considered to lie in the center of this equilateral triangle. 39. Blood pressure

The pressure exerted by the blood against the walls of the blood vessels, especially the arteries. It varies with the strength of the heartbeat, the elasticity of the arterial walls, the volume and viscosity of the blood, and a person's health, age, and physical condition. In the healthy young adult, the pressure at the height of each pulse, called the systolic pressure, is about 120 mmHg and at its lowest point, called the diastolic pressure, it is about 80 mmHg. The difference between these two pressures, about 40 mmHg, is called the pulse pressure. 40. Central venous pressure The pressure in the thoracic vena cava near the right atrium is called central venous pressure (CVP). CVP is influenced by a number of factors, including cardiac output, respiratory activity, contraction of skeletal muscles and hydrostatic forces (i.e., gravity). 41. Renin-angiotensin system The renin-angiotensin system plays an important role in regulating blood volume, arterial pressure, and cardiac and vascular function. While the pathways for the renin-angiotensin system have been found in a number of tissues, the most important site for renin release is the kidney. Sympathetic stimulation, renal artery hypotension, and decreased sodium delivery to the distal tubules stimulate the release of renin by the kidney. Renin is an enzyme that acts upon a circulating substrate (angiotensinogen) to release a 10-amino acid peptide, angiotension . Vascular endothelium, particularly in the lungs, has an enzyme, angiotensin converting enzyme (ACE), that cleaves off two amino acids to form the octapeptide, angiotensin II (AII). 42. Nitric oxide synthase The enzyme that catalyzes the formation of NO from oxygen and arginine is nitric oxide synthase, a very complex enzyme containing five bound cofactors/prosthetic groups, FAD, FMN, haem, tetrahydrobiopterin (BH4) and Ca2+-calmodulin (CaM), and a heme group which is part of the catalytic site. In mammals, three distinct genes encode NOS isozymes: neuronal (nNOS or NOS1), cytokineinducible (iNOS or NOS2) and endothelial (eNOS or NOS3). 43. Vasomotor center The vasomotor center, located bilaterally mainly in the reticular substance of the medulla and of the lower third of the pons, is responsible for the overall control of blood distribution and pressure throughout the body. This center transmits parasympathetic impulses through the vagus nerves to the heart and transmits sympathetic impulses through the cord and peripheral sympathetic nerves to all or almost all the blood vessels of the body. 44. Baroreceptor reflex The baroreceptor reflex is the body's rapid response system for dealing with changes in blood pressure. This reflex is initiated by stretch receptors, called either baroreceptors or pressoreceptors, which are located in the walls of several of the large systemic arteries. If a rise in

arterial pressure stretches the baroreceptors and causes them to transmit signals into the central nervous system. Feedback signals are then sent back through the autonomic nervous system to the circulation to reduce arterial pressure downward toward the normal level. 45. Intrapleural pressure Intrapleural pressure (pleural pressure) is the pressure of the fluid in the narrow space between the lung pleura and the chest wall pleura. As noted earlier, this is normally a slight suction, which means a slightly negative pressure. The normal pleural pressure at the beginning of inspiration is about -5 centimeters of water, which is the amount of suction that is required to hold the lungs open to their resting level. Then, during normal inspiration, the expansion of the chest cage pulls outward on the lungs with still greater force and creates a still more negative pressure to an average of about -7.5 centimeters of water. 46. Surfactant Surfactant is secreted by type II alveoli epithelial cells. It is a complex mixture of several phospholipids, proteins, and ions. The most important components are the phospholipids dipalmitoylphosphatidylcholine, surfactant apoproteins, and calcium ions. The dipalmitoylphosphatidylcholine, along with several less important phospholipids, is responsible for reducing the surface tension. 47. Tidal volume The tidal volume is the volume of air inspired or expired with each normal breath. It amounts to about 500 milliliters. 48. Vital capacity The vital capacity is the maximum amount of air a person can expel from the lungs after first filling the lungs to their maximum extent and then expiring to the maximum extent (about 4600 milliliters). 49. Alveolar ventilation Alveolar Ventilation (VA) is the amount of new air at which reaches functional respiratory units (ie, alveoli, alveolar sacs, alveolar ducts, and respiratory bronchioles) per minute. VA = (tidal volume - deadspace) x respiratory rate 50. Respiratory membrane Gas exchange between the alveolar air and the pulmonary blood occurs through the membranes of all the terminal portions of the lungs, not merely in the alveoli themselves. These membranes are collectively known as the respiratory membrane, also called the pulmonary

membrane. It includes: (1) A layer of fluid lining he alveolus and containing surfactant that reduces the surface tension of the alveolar fluid; (2) The alveolar epithelium composed of thin epithelial cells; (3) An epithelial basement membrane; (4) A thin interstitial space between the alveolar epithelium and the capillary membrane; (5) A capillary basement membrane that in many places fuses with the alveolar epithelial basement membrane; (6) The capillary endothelial membrane. 51. Ventilation-perfusion ratio Ventilation-perfusion ratio: the ratio between the amount of fresh air brought into the alveoli in the lungs and the amount of blood flow past the alveoli in the lungs. Normal Ventilationperfusion ratio = 0.8. This ratio in a patient can be higher than normal (indicating dead space) in a patient (for a number of clinical reasons) or, of course, it can be lower than normal (right to left shunt) in a patient for other clinical reasons. 52. Oxygen-hemoglobin dissociation curve The oxygen-hemoglobin dissociation curve relates oxygen saturation (SO 2) and partial pressure of oxygen in the blood (PO 2), and is determined by what is called "hemoglobin's affinity for oxygen," that is, how readily hemoglobin acquires and releases oxygen molecules from its surrounding tissue. The oxygen dissociation curve is shifted to the right (oxygen affinity for hemoglobin is reduced) by an increase in hydrogen concentration, PaCO 2, temperature and concentration of 2,3-diphosphoglycerate (2,3-DPG) in the red blood cells. 53. Hering-Breuer inflation reflex When the lungs become overstretched, stretch receptors, which are located in the muscular portions of the walls of the bronchi and bronchioles throughout the lungs, transmit signals through the vagi into the dorsal respiratory group of neurons. These signals activate an appropriate feedback response that switches off the inspiratory ramp and thus stops further inspiration. This is called the Hering-Breuer inflation reflex. This reflex also increases the rate of respiration, the same as is true for signals from the pneumotaxic center. 54. Basic electrical rhythm (BER) or slow waves Basic electrical rhythm is the spontaneous rhythmic, subthreshold depolarization of the cell membrane in the gastrointestinal tract. Its intensity usually varies between 5 and 15 millivolts, and its frequency ranges in different parts of the human gastrointestinal tract between 3 and 12 per minute. It dictates frequency of contractions but does not always cause contraction.

55. Gastrointestinal (GI) hormones Gastrointestinal (GI) hormones are the hormones synthesized by a large number of endocrine

cells within the gastrointestinal tract. They are most important in controlling digestive function, releasing other hormones and trophic action.

56. Receptive relaxation (Storage function of the stomach) Receptive relaxation is a reflex in which the gastric fundus dilates when food passes down the pharynx and the esophagus. When food enters the stomach, a vagovagal reflex from the stomach to the brain stem and then back to the stomach reduces the tone in the muscular wall of the body of the stomach so that the wall bulges progressively outward, accommodating greater and greater quantities of food up to a limit in the completely relaxed stomach of 1.0 to 1.5 liters. The pressure in the stomach remains low this limit is approached. 57. Mucus-HCO3- barrier Mucus-HCO3- barrier is an alkaline gel layer of mucus which is mainly insoluble and coats the stomach mucosa. It is often more than 1 millimeter thick. The importance functions of the mucus- HCO3- barrier are protecting the gastric mucosa against injury by acid or pepsin, and contributing to lubrication of food transport. 58. Intrinsic factor Intrinsic factor is a glycoprotein secreted by parietal cells of the gastric mucosa. It is essential for absorption of vitamin B12 in the ileum.