MedInTO Medicine and Surgery

Physiology of Systems

Physiology of Systems

Academic year 2023/2024

Sommario del corso

• Course objectives
• Results of learning outcomes
• Program
• Course delivery
• Learning assessment methods
• Support activities
• Suggested readings and bibliography
• Notes
• Teaching tools
• Course card

Course objectives

Starting from an anatomical, biochemical, biological and physical basis, the teaching program aims to illustrate the function of the various organs and systems. Control mechanisms and functions of body systems and their clinical relevance will be the core of the course.

To provide in-depth of knowledge in the physiological concepts essential for understanding mechanisms of disease. In particular, the student should be able to:

• Describe cardiac muscle function and properties;
• Discuss unique characteristics of cardiac muscle;
• Discuss electrophysiology of the heart: the conduction system;
• Describe normal Electrocardiogram (ECG), and the main changes of ECG in cardiac arrhythmias;
• Describe and graph cardiac cycle details;
• Describe cardiac function in relation to change of preload, afterload and contractility;
• Understand the pressure, volume and flow changes during the cardiac cycle;
• Describe expected auscultation sounds in physiology and pathophysiology (murmurs);
• Discuss factors that related cardiac output to venous return;
• Delineate the way cardiac output can be regulated;
• Discuss the fundamentals of fluid dynamics and methods to measure blood flow and pressure;
• Describe and graph arterial pressure in systemic and pulmonary circulations;
• Describe microcirculation and lymphatics;
• Discuss the regulation of arterial pressure (brief term, middle-term and long-term regulation);
• Outline the neural, metabolic and auto-regulative aspects of the cardiovascular system;
• Discuss local control of blood flow (autoregulation and paracrine effects);
• Discuss unique characteristics and phasic aspects of coronary flow;
• Describe cerebral, splanchnic, and cutaneous circulation;
• Describe transcapillary transport;
• Describe renal body fluids regulation;
• Describe structure and function of the kidney and nephrons;
• Describe and discuss renal clearance;
• Describe glomerular filtration rate and renal hemodynamics;
• Describe transport properties of nephron segments;
• Discuss urine concentration and dilution;
• Describe Na+ balance and regulation of extracellular fluid volume;
• Discuss K+ balance;
• Describe Ca2+ and phosphate balance;
• Describe pulmonary mechanics (pressure, volume, compliance, resistance, wall tension);
• Describe and graph lung volumes and capacity and alveolar ventilation;
• Describe unique characteristics of the pulmonary circulation;
• Describe pulmonary gas exchange;
• Discuss and graph oxygen and carbon dioxide transport;
• Discuss respiratory control;
• Discuss acid-base balance and role of buffers, kidneys and lungs;
• Describe the characteristics of the enteric nervous system and its interaction with the extrinsic nervous system in the regulation of the functions of each GI segment;
• Describe of GI reflexes and neurotransmitters involved;
• Describe the functions of each GI segment (secretion, digestion, absorption and motility);
• Indicate the composition of secretion of each GI segment and annexed glands; description of the functions of their components;
• Discuss the regulation of the secretory processes;
• Describe the cell type and anatomical location of the endocrine cells responsible for the production of the major GI hormones and their cellular targets; describe the stimuli that promote and inhibit the release;
• Describe the digestion of the nutrients (starch, protein and lipid) and of the relevant enzymes;
• Describe the membrane transport mechanisms responsible for the absorption of: digestion products of sugars, proteins, lipids, vitamins and electrolytes by the intestinal epithelial cells;
• Describe the enterohepatic circulation and reuptake of bile acids/salts;
• Describe the characteristics of the spontaneous and stimulated electrical activity of GI smooth muscles (electrical slow waves, action potentials, and contraction) and the role of Cajal cells;
• Describe the stomach emptying and its regulation, as well as of the major motor patterns and their regulation in the stomach, small and large intestine.
• Understand the sequence of events leading from sensory transduction to conscious perception in the main sensory systems

Results of learning outcomes

At the end of the course, the students shall have an in-depth knowledge of the functional mechanisms of the human body. To this aim, the student should be able to describe and discuss the main physiological mechanisms and, when necessary, draft and explain the graphs relative to the physiology of cardiovascular, renal, pulmonary and gastro-enteric systems. As a future MD, the student should also be able to discuss physiological phenomena of different organs ad their integrations, for a better understanding of diseases and therapeutic approaches to restore the physiological conditions.

Program

Cardiovascular system physiology

• General organization and functional anatomy of heart and vessels.
• Physiology of the cardiac muscle.
• Comparison of cardiac versus skeletal and smooth muscle: action potential and refractory period, excitation-contraction coupling, mechanical features.
• The tissues of the heart: cardiac muscle (myocardium), pacemaker tissue and conductive tissue.
• The properties of the heart: chronotropy, dromotropy, inotropy and bathmotropy.
• The heart as a pump; the cardiac cycle; cardiac volumes; heart sounds.
• Regulation of heart-pumping; intrinsic regulation Starling's law; preload and afterload; extrinsic regulation: nervous, humoral and pharmacological regulation; cardiac work.
• Specialized excitatory, conductive system of the heart and the spread of the impulse.
• Electrophysiology of the heart; the normal electrocardiogram; electrocardiographic leads (bipolar, augmented unipolar and precordial leads); vectorial analysis and electrocardiographic interpretation; cardiac arrhythmias and their interpretation.
• Pressure flow and vascular resistance; regulation of cardiovascular function: intrinsic and extrinsic control; microcirculation and lymphatic system; local and humoral control of blood flow by the tissues.
• Baroreceptor reflex and other cardiovascular reflexes; control of arterial pressure: rapid, middle and long term regulation; cardiac output, venous return and their regulation; control of the cardiac output.
• Coronary circulation and other specialized circulations (cerebral, cutaneous, skeletal muscle circulation); physiological adaptations to specific conditions; 

Respiratory system physiology

• Pulmonary circulation; structure, function and mechanisms of the respiratory system. Pulmonary Ventilation; anatomical and functional dead spaces; alveolar ventilation.  
• Mechanics of the respiration; alveolar and pleural pressures and volume changes during respiration; pulmonary volumes and capacity and their determination methods; compliance of the lung; surfactant and surface tension; lung hysteresis and respiration work; pneumothorax.
• Exchange and transport of gases: the physical principle of gas; composition of air; diffusion of gas through the respiratory membranes; ventilation/perfusion ratio; transport of oxygen and carbon dioxide in the blood (Bohr and Haldane effects); oxyhemoglobin dissociation curve and factors that shift it.
• Control of breathing: respiratory centre in the central nervous system; chemical control of respiration; peripheral chemoreceptor system.

Renal system physiology

• The body fluids and kidneys; the nephron and the renal circulation.
• Formation and composition of urine; glomerular filtration mechanism and glomerular filtration rate (GFR); tubular processing of the glomerular filtrate from the beginning of the proximal tubule to the end of the collecting duct; autoregulation of GFR and renal blood flow; hyperosmolarity of renal medulla and the countercurrent multiplier and exchanger; dilution and concentration of urine and ADH.
• Bicarbonate reabsorption and urine acidification.
• Renal clearances: methods to quantify kidney function; clearance of inulin, PAI, urea and glucose; the filtration fraction; tubular secretion and reabsorption: TmPAI and TmG.
• Juxtaglomerular apparatus; renin-angiotensin-aldosterone system.
• Regulation of extracellular fluid, osmolarity and sodium concentration; renal regulation of potassium, calcium; micturition.
• Regulation of acid-base balance: buffers, respiratory regulation and renal control of acid-base balance; concepts of base excess; anion gaps.

Gastrointestinal system physiology 

• General principles of gastrointestinal function; neural control of gastrointestinal function: autonomic extrinsic and intrinsic nervous systems and their connections; gastrointestinal reflexes.
• Processes in the mouth: mastication, saliva secretion, composition and function, nervous control of salivary secretion; swallowing; physiology of the oesophagus.
• Processes in the stomach: gastric mucosa and glands; filling of the stomach; secretion, composition and activity of the gastric juice; movement of the stomach; emptying of the stomach; nervous and humoral controls of gastric activities.
• Processes in the small intestine.
• Pancreatic secretion and its nervous and humoral control; composition of the pancreatic juice and activity of the relevant enzymes.
• The bile: composition, production and storage in the gallbladder; function of the biliary salts; biliary pigments; entero-hepatic circulation of biliary salts.
• Small intestine secretion and enzyme activity; digestion and absorption of macro and micro-nutrients; motility: segmentation and propulsive movements; ileocecal valve and emptying of the small intestine; nervous and humoral controls of motility.
• Processes in the large intestine: secretion, absorption; motility: haustrations and mass movements; defecation.

Central processing of sensory signals 

Central processing of:

• Vision
• Hearing
• Taste and olfaction
• Touch and proprioception
• Pain and analgesia

Course delivery

Learning assessment methods

Whenever necessary, the exams will be performed online following the indications released by the University (via Webex virtual room).

The exam will consist of two written tests in attendance (on Moodle platform). The first written test includes one or more of the following question types (multiple-choice, true/false, matching) with a penalty for the wrong answers.  Only students who have obtained at least 18/30 can take the second part of the written exam which consists of one or two open questions. The final mark of the written exam will be given by the weighted average of the two written tests.

At the end of the correction of the written tests, the oral exam can be requested by the Examination Board or by the Student, to modify the final mark (only when the final mark is equal or higher than 18/30). The student must be able to draw and describe physiology diagrams showing them in the WebEx virtual room, whenever necessary

Support activities

Various optional activities may be available on the Platform (http://medicina.i-learn.unito.it), concerning some verification quizzes at the end of some chapters.

Evaluation test: At the end of each section of the course, as an evaluation test, the students will be given a series of questions (multiple choice; open questions or students will be requested to write a short essay). The evaluation test has the main objective to indicate the student the degree of his/her understanding of the discipline.

• PowerPoint slides provided and video-clips suggested by professors.
• Textbooks suggested:
  • Guyton and Hall, Textbook of Medical Physiology, Elsevier.
  • Ganong's, Review of Medical Physiology, McGraw-Hill Education.
  • Berne and Levy, Physiology, Elsevier.
• Further reading:
  • Basic Cardiovascular Physiology: From molecules to translational medical science by Pasquale Pagliaro, Claudia Penna and Raffaella Rastaldo. River Publishers (ISBN: 978-87-7022-200-6 (Hardback) 978-87-7022-199-3 (Ebook)).
  • Levick JR. An Introduction to Cardiovascular Physiology. 3rd Edition Arnold.

• Central processing of sensory signals:

  Dale Purves, George J. Augustine, David Fitzpatrick, William C. Hall, Anthony-Samuel LaMantia, and Leonard E. White (editors). “Neuroscience”.  Oxford University Press

  Eric R. Kandel, James H. Schwartz, Thomas M. Jessell, Steven A. Siegelbaum and A. J. Hudspeth. “Principles of neural science” (5th edition). McGraw-Hill

Notes

Students with DSA or disabilities are kindly requested to take note of the reception services and support services offered by the University of Turin, and in particular of the procedures required for exam support.

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