90194 - Apparatuses Physiology (LZ-A)

Course Unit Page

Academic Year 2021/2022

Learning outcomes

At the end of the Course, the student will know the basic aspects of organism function in an increasing order of complexity, as outlined by the following levels of integration: molecular, cellular, of either organ or apparatus. In particular, the student will know the integrated normal functions in humans of the following systems - cardiovascular - renal - respiratory – gastro-enteric – nervous.

Course contents

Corso di Laurea in Medicina e Chirurgia

Somatosensory sensibility

Organization of somatosensory pathways of the body and the face. Thalamic and cortical somatosensory areas. Pain: nociceptive and neuropathic pain, hyperalgesia, referred pain. Peripheral modulation and central control of pain.

Control of Movement

Final common pathway: the motor neuron. Organization of descending motor pathways. Function of medial and lateral system pathways. Cortical and brainstem control of movement. Regulation of movement: the cerebellum (afferent and efferent morphofunctional organization) basal ganglia (morphofunctional organization, direct pathway and indirect pathway).

Autonomic Nervous System

Morphofunctional organization of the autonomic nervous system: sympathetic, parasympathetic and enteric divisions. Action of the sympathetic and parasympathetic systems on the main organs. Adrenal medulla. Central control of the autonomic function. Micturition. Thermogenetic and thermolytic mechanisms. Skin circulation..

Digestive system: oral and gastric functions

Morphofunctional organization of the esophagus and stomach. Cephalic, oral, esophageal and gastric phases of motor, secretory and absorptive processes.

Digestive system: intestinal functions

Morphofunctional organization of the intestine. Intervention of the small intestine and colon in motor, secretory and absorptive processes,. Pancreatic and biliary secretions.

Functional organization of the vascular system

Elasticity and function of large arteries. Application of Laplace's law to blood vessels. Central and peripheral arterial pulse. Function of the arterioles. Regulation of capillary flow. Role of the endothelium and smooth muscle in the regulation of blood flow. Function of the lymphatic vessels. Function of the venous vessels.

Integrated control of the cardiovascular system

Central venous pressure. Integrated control of the cardiovascular system: curves of cardiac function, curves of vascular function. Relating cardiac function curves to vascular function curves.

Blood pressure and its regulation

Reflex regulation of arterial blood pressure: localization, structure and functional characteristics of the aortic and carotid baroreceptors; cardiac and vasomotor reflexes elicited by aortic and carotid baroreceptors. Vasomotor reflexes elicited by cardiac receptors. The renin-angiotensin-aldosterone system in blood pressure regulation.

Determination of blood pressure (LABORATORY PRACTICALS)

Measurement of blood pressure by the conventional sphygmomanometry of Riva-Rocci.

Stroke Volume

Genesis and propagation of the cardiac impulse. Electromechanical coupling during the cardiac cycle. Movement of valves, changes in pressure and volume of atria and ventricles during the cardiac cycle. Duration of different phases of the cardiac cycle. Origin of heart sounds.

Cardiac Output

Stroke volume and cardiac output. Determination of the cardiac output by means of the Principle of Fick and the indicator dilution method. Pressure-volume relationship in the left ventricle. Heterometric (Frank-Starling mechanism) and homeometric (increased heart rate, response to the increase in diastolic pressure) intrinsic regulation of myocardial mechanical activity. Extrinsic regulation (nervous and humoral) of the electrical and mechanical myocardial activity. Indices of myocardial contractility.

Cardiac metabolism

Changes in coronary blood flow during the cardiac cycle. Nervous and humoral regulation of the coronary circulation. Cardiac metabolism. Work of the heart. Application of Laplace's law to the heart.

Electrocardiogram (LABORATORY PRACTICALS)

Physics of electrocardiography: volume conduction, equivalent electric dipole and electric field vector. Recording techniques of cardiac electrical activity: bipolar derivations, monopolar augmented and precordial leads. Instantaneous mean vector and genesis of the waveforms in bipolar derivations. Calculation of mean cardiac vector (ventricular electrical axis).

Dynamic respiratory mechanics

Functions of the respiratory tract. Action of the respiratory muscles. Pleural pressure. Changes in the alveolar and pleural pressure, in air flow during a respiratory cycle. Dynamic respiratory mechanics: flow and resistance in the airways; maximal expiratory flows; flow-volume diagrams; dynamic airways compression.

Spirometry 1 (LABORATORY PRACTICALS)

Determination of flow-volume curves.

Static respiratory mechanics.

Static respiratory mechanics: pressure-volume curves of the lung, of the chest and of the chest-lung system; compliance; application of the Laplace's law to the lung; contribution of the surface tension to the pulmonary elasticity; role of pulmonary surfactant. Work of breathing.

Spirometry 2 (LABORATORY PRACTICALS)

Direct and indirect spirometry: measurement of lung volumes and capacities.

Pulmonary gas exchange

Composition of atmospheric and alveolar air. Pulmonary ventilation and alveolar ventilation. Measurement of dead space. Alveolar-capillary barrier. Measurement of pulmonary diffusion capacity. Pulmonary circulation. Ventilation-perfusion ratio: regional differences in ventilation-perfusion ratio; excess of ventilation with respect to perfusion; excess of perfusion with respect to ventilation.

Transport of oxygen and carbon dioxide in the blood

Forms of oxygen transport in the blood. Functional significance of the hemoglobin dissociation curve. Quantitative aspects of the transport of oxygen in the blood. Types of hypoxia. Forms of transport of carbon dioxide in the blood. Functional significance of the curve of transport of carbon dioxide. Quantitative aspects of the transport of carbon dioxide in the blood. Interaction between the transport of oxygen and carbon dioxide.

Control of breathing

Ventilatory responses to changes in the arterial partial pressure of oxygen and carbon dioxide and concentration of hydrogen ion. Function of the peripheral and central chemoreceptors in the regulation of pulmonary ventilation. Interaction between chemical stimuli in the regulation of pulmonary ventilation. Control of breathing by pontine and medullary respiratory centers. Lung receptors and respiratory reflexes.

Functions of the renal glomerulus

Plasma and renal blood flow. Ultrafiltration process. Glomerular ultrafiltration rate: clearance of inulin; plasma creatinine. Filtration fraction. Autoregulation of renal blood flow and glomerular filtration rate.

Functions of the renal tubule

Absorption and secretion in the nephron. Reabsorption of sodium chloride and water. Control of renal potassium homeostasis. Renal clearance.

Regulation of body fluid osmolality

Fluid compartments of the body. Neurohypophyseal secretion of antidiuretic hormone. Renal mechanisms for concentration and dilution of urine. Osmolar clearance and free-water clearance.

Regulation of body fluids volume

Fluid compartments of the body. Effective circulating volume. Regulation of renal excretion of water and sodium chloride. Mechanisms of regulation of extracellular fluid volume: volume receptors; actions of the sympathetic nervous system, the renin-angiotensin-aldosterone system and natriuretic peptides.

Regulation of acid-base balance

Concentration of hydrogen ions in the blood and blood buffer systems. Tubular transport of hydrogen ions and bicarbonate. Formation of ammonium ions. Kidney and respiratory responses to changes in acid-base balance. Primary acid-base alterations: acidosis and alkalosis of respiratory and metabolic origin; compensatory responses to primary acid-base alterations..

Regulation of serum calcium and phosphorus

Effects of parathyroid hormone, vitamin D and calcitonin on the mobilization of the bone matrix and the absorption and excretion of calcium and phosphate. Regulation of the secretion of the parathyroid hormone and calcitonin. Endogenous synthesis of vitamin D.

Regulation of energy metabolism

Energy balance and energy stores in the body. Measurement of energy metabolism by means of indirect calorimetry. Structure and functions of adenohypophysis. Nervous and endocrine regulation of energy stores and metabolism (insulin, glucagon, glucocorticoids, epinephrine, leptin, thyroid hormones, growth hormone).

Reproductive glands. Growth

The ovaries: oogenesis and ovulation, corpus luteum formation secretion and actions of estrogen and progesterone; the menstrual cycle. The testes: spermatogenesis, secretion and actions of androgens. Growth hormone and thyroid hormones influences on the development and growth.

Readings/Bibliography

TEXTBOOKS

R.M. Berne, M.N. Levy, FISIOLOGIA (a cura di, B.R. Koeppen, B.A. Stanton), 6a Edizione, Milano Casa Editrice Ambrosiana, 2010 (ISBN 8808182746).

Berne & Levy Physiology, (B.M. Koeppen and B.A. Stanton, Editors) 6th revised edition, Philadelphia, Mosby Elsevier, 2010 (ISBN: 032307362X).

Teaching methods

Lectures covering the theoretical Course Program. The Course consists of 13 CFU, corresponding to 104 hours of teaching. The Course is held in parallel with the Course of Applied Physiology (1CFU) consisting in 17 hours of Laboratory Practicals, either shown to large groups of students or directly performed by small groups of students. The Course is held by Prof. Amici (7 CFU), 7 and Prof. Ciani (6 CFU). The Course of Applied Physiology is held by Dr. Trazzi. Slides shown during lectures are mostly taken from suggested readings. If not, the reference is indicated.

Assessment methods

The entire Physiology Course consists of three parts. The first (Cellular Physiology) is held during the first semester, the second (Apparatus Physiology) and the third (Applied Physiology) are held during the second semester. The exam is unique and is held at the end of the second semester, but the student can take a mid-term written test with alternate-choice questions at the end of the Cellular Physiology Course. The mid-term test includes 44 questions. The final score of the test is given by the algebraic sum of the score of the correct answers (1 point), of the wrong answers (-0.6 points) and of answers not given (0 points), converted into thirtieths. The mid-term test is considered sufficient with a score of 18/30. Students who accept the grade of the mid-term test take the final oral exam only on the parts relating to the Physiology of Apparatus and Applied Physiology. During the oral exam the student is questioned on topics drawn randomly with a balanced procedure (two questions regarding Apparatus Physiology and Applied Physiology, a third question on Cellular Physiology if the mid-term test has not been taken) by different teachers for each topic covered. If the answer is considered sufficient, each question is evaluated with a variable score between 18/30 and 30/30 with honors. The achievement by the student of a coherent vision of the topics discussed in the exam combined with their critical use, the demonstration of an expressive mastery and ability to use specific biomedical language terms are evaluated with marks of excellence. The mostly mechanical and / or mnemonic knowledge of the subject, the ability of synthesis and analysis not completely articulated, and / or the use of a correct but not always appropriate language lead to intermediate-grade evaluations; training gaps and / or inappropriate language in a context of basic yet complete knowledge of the exam material lead to marks that do not exceed sufficiency. Training and significant knowledge gaps concerning the teaching materials offered during the course and inappropriate language are negatively evaluated. Each of the three questions weighs one third in the calculation of the final grade. Insufficient evaluation of the answer to even one of the three questions renders the test insufficient.

Teaching tools

Teaching tools used for lectures: 2 digital Video projectors, PC, Overhead digital projector and camera. Equipment for Laboratory Practicals: Volume and Flow Spirometers; Electrocardiography machines; Blood pressure manometers; Pulse oximetry equipment; Vascular and heart ultrasound echo-doppler; Equipment for standard Electroencephalography and event related potentials assessment; Cycle-ergometer. Slides concerning each topic of the Course Program can be downloaded from the "Insegnamenti On Line" by students enrolled at the University of Bologna (University institutional username and password required).

Office hours

See the website of Elisabetta Ciani