MedInTO Medicine and Surgery

Physiology of systems

Physiology of systems

Academic year 2018/2019

Sommario del corso

• Course objectives
• Results of learning outcomes
• Course delivery
• Learning assessment methods
• Program
• Suggested textbooks and readings
• Teaching tools

Course objectives

Starting from 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 an 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; Myocardial infarction and Myopathies

Describe cardiac function in relation to change of preload, afterolad and contractility

Describe and graph Cardiac Cycle details

Understand the pressure, volume and flow changes during cardiac cycle

Describe expected Auscultation Sounds in Physiology and Pathophysiology (murmurs)

Discuss factors that affect cardiac output and 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 regulation of Arterial Pressure (brief term, middle term and long-term regulation)

Outline the neural, metabolic and auto-regulative aspects of 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

Discuss Hemorrhage, and Shock

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 about Urine Concentration and Dilution

Describe Na+ Balance and Regulation of Extracellular Fluid Volume

Discuss K+ Balance

Describe Ca2+ and Phosphate Balance

Discuss Integrative and Pathophysiological Aspects; Hypertension

Describe Pulmonary Mechanics (pressure, volume, compliance, resistance, wall tension)

Describe and graph Lung Volumes and Capacity and Alveolar Ventilation

Describe unique characteristics of 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 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 re-uptake 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). 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.

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.

Course delivery

Teaching is organized both as lectures and active learning. The course includes lectures with projection of slides and video-clips, home readings and vision of movies based on physiology topics. Activities in small groups will be organized in teaching rooms with devices and simulation. This active learning promotes the acquisition of knowledge.

Learning assessment methods

Evaluation tests:

At the end of each section of the course, as evaluation test, the students will be given a series of questions (multiple choice and open questions). A final score will be calculated on a scale from 0 to 30, in proportion to the number of questions correctly answered.The evaluation test has the main aim to indicate the student the degree of his/her understanding of the discipline.

EXAM:

At the end of the entire course a written and oral examination will be taken with an Examination Board, including all the teachers of the course.

Written tests (preparatory to oral tests):

The written test will be composed as follow:

• Four (4) closed questions for each CFU (generally multiple choice questions: only 1 answer is correct and the other answers are wrong distractors).

plus

• A single open-ended question.

The students will have 1 minute for each closed question plus 3 min for the open-ended question to complete the written text.

Score:

-       Closed questions: +1 point for each right answer; 0 points for each answer not given; - 0.25 points for each wrong answer.

-       Open-ended questions: from - 2 to + 4 points.

The score for each written test will be then expressed in in thirtieths.

The Score obtained in the written exam:

a)    If less than half of the maximum achievable score (equal or less than 15/30), the student is automatically considered "Retired from the exam"

b)    If it is superior a half (15/30 or more) the student is admitted to the oral examination;

The written test score is valid for maximum 6 months (the deadline is the last day of the 6^th month).

Oral exam: It consists of a discussion of the results of the written tests and a check of the overall preparation.

The oral examination can be sustained in the same day and the final grade will be assigned ass follow: adding or subtracting from the written test score a maximum of 7 points. The student passes the exam if is final grade is equal or greater than 18/30.

N.B.: Even if the written test score is equal to or greater than 25/30, the Board has the duty and right to invite the student to withdraw from the exam and return to the next useful examination appeal, if serious deficiencies are found in the knowledge of the discipline topics. This decision requires the unanimity of the Examination Board.

Those who do not pass the oral exam must repeat the entire exam: written test and oral examination.

Program

Cardiovascular system

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 Exicitatory, 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 cardio-vascular 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 cardiac output.

Coronary circulation and other specialized circulations (Cerebral, cutaneous, skeletal muscle circulation). Physiological adaptations to specific conditions. Blood: a liquid tissue.

Respiratory system

Pulmonary circulation. Structure, function and mechanisms of 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: 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 center in the central nervous system; chemical control of respiration; peripheral chemoreceptor system.

Renal system

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. Osmolar clearance and free water clearance. The filtration fraction. Tubular secretion and reabsorption: Tm_PAI and Tm_G.

Juxtaglomerular apparatus; Renin-Angiotensin-Aldosterone system.

Regulation of extracellular fluid, osmolarity and sodium concentration. Renal regulation of potassium, calcium, phosphate and magnesium. Micturition.

Regulation of acid-base balance: buffers, respiratory regulation and renal control of acid-base balance. Concepts of base excess; anion gaps and osmolar gap in acid-base disorders.

Gastrointestinal 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 esophagus.

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 micronutrients. Motility: Segmentation and propulsive movements; Ileocecal valve and emptying of small intestine. Nervous and humoral controls of motility.

Processes in the large intestine: secretion, absorption. Motility: haustrations and mass movements. Defecation.

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:

Levick JR. An Introduction to Cardiovascular Physiology. 3^rd Edition Arnold

• Teaching materials
• Exams and finals
• Go to Moodle
• Visit the forums