The human body is approximately 60% water, with total body water being around 42L. The water is divided into intracellular fluid (28L), interstitial fluid (10L), plasma (3L), and transcellular fluid (1L). The major ions in extracellular fluid are Na+ (142 mmol/L), Cl- (105 mmol/L), and HCO3- (27 mmol/L). In intracellular fluid, the major ions are K+ (160 mmol/L) and phosphate (100 mmol/L). Plasma osmolarity is tightly regulated at around 290 mosm/L through mechanisms involving sodium, water, the renin-angiotensin-aldosterone system,
Intestines(movements and secretions of small and large intestines ) The Guyto...Maryam Fida
Intestines(movements and secretions of small and large intestines)
Distended Portion of small intestine with chyme stretching concentric contractions at intervals lasting a fraction of a minute These contraction causes “Segmentation” of the small intestine ---forms spaced segments new points every time chopping chyme 2-3 times/min mixing with intestinal secretions maximum frequencyof segmentation contraction depends on frequency of BER (Basic electrical rhythm) i.e. In duodenum and proximal jejunum is 12/min and in terminal ileum is 8-9/min.
Atropine blocks the segmentation
law of gut
The peristaltic reflex +anal direction of movement of the peristalsis is called “LAW OF GUT”
Transport of oxygen (the guyton and hall physiology)Maryam Fida
Supply of oxygen to tissues mainly involves two systems i.e. respiratory system and the cardiovascular system.
Supply of oxygen to tissues depends upon
Adequate PO2 in atmospheric air
Adequate pulmonary ventilation
Adequate gaseous exchange in the lungs
Adequate uptake of oxygen by the blood
Adequate blood flow to the tissues
Adequate ability of the tissues to utilize oxygen
Oxygen diffuses from the alveoli into the pulmonary capillary blood because the oxygen partial pressure (Po2) in the alveoli is greater than the Po2 in the pulmonary capillary blood.
In the other tissues of the body, a higher Po2 in the capillary blood than in the tissues causes oxygen to diffuse into the surrounding cells.
The Po2 of the gaseous oxygen in the alveolus averages 104 mm Hg,
whereas the Po2 of the venous blood entering the pulmonary capillary at its arterial end averages only 40 mm Hg
Therefore, the initial pressure difference that causes oxygen to diffuse into the pulmonary capillary is 104 – 40, or 64 mm Hg.
About 98 percent of the blood that enters the left atrium from the lungs has just passed through the alveolar capillaries and has become oxygenated up to a Po2 of about 104 mm Hg.
Another 2 per cent of the blood which supplies mainly the deep tissues of the lungs and is not exposed to lung air. This blood flow is
called “shunt flow,” meaning that blood is shunted past the gas exchange areas
One gram of Hb can bind 1.34 ml of Oxygen
Normal level of Hb is 15 grams/dL
Thus 15 grams of hemoglobin in 100 milliliters of blood can combine with a total of almost exactly 20 milliliters of oxygen if the hemoglobin is 100 per cent saturated
This is usually expressed as 20 volumes per cent
Hemoglobin is a conjugated protein consisting of heme and globin.
The ferrous form can bind oxygen.
Hemoglobin molecule consists of four subunits each consists of one heme and one polypeptide chain
Each subunit can bind one molecule of Oxygen
Oxygenation is a very rapid and reversible process and it can occur in 0.01 seconds
When PO2 is high, oxygen binds with Hb to form Oxyhemoglbin
When PO2 is low oxygen leaves Hb to form Deoxy Hb.
Factors that shift the oxygen hemoglobin dissociation curve
Intestines(movements and secretions of small and large intestines ) The Guyto...Maryam Fida
Intestines(movements and secretions of small and large intestines)
Distended Portion of small intestine with chyme stretching concentric contractions at intervals lasting a fraction of a minute These contraction causes “Segmentation” of the small intestine ---forms spaced segments new points every time chopping chyme 2-3 times/min mixing with intestinal secretions maximum frequencyof segmentation contraction depends on frequency of BER (Basic electrical rhythm) i.e. In duodenum and proximal jejunum is 12/min and in terminal ileum is 8-9/min.
Atropine blocks the segmentation
law of gut
The peristaltic reflex +anal direction of movement of the peristalsis is called “LAW OF GUT”
Transport of oxygen (the guyton and hall physiology)Maryam Fida
Supply of oxygen to tissues mainly involves two systems i.e. respiratory system and the cardiovascular system.
Supply of oxygen to tissues depends upon
Adequate PO2 in atmospheric air
Adequate pulmonary ventilation
Adequate gaseous exchange in the lungs
Adequate uptake of oxygen by the blood
Adequate blood flow to the tissues
Adequate ability of the tissues to utilize oxygen
Oxygen diffuses from the alveoli into the pulmonary capillary blood because the oxygen partial pressure (Po2) in the alveoli is greater than the Po2 in the pulmonary capillary blood.
In the other tissues of the body, a higher Po2 in the capillary blood than in the tissues causes oxygen to diffuse into the surrounding cells.
The Po2 of the gaseous oxygen in the alveolus averages 104 mm Hg,
whereas the Po2 of the venous blood entering the pulmonary capillary at its arterial end averages only 40 mm Hg
Therefore, the initial pressure difference that causes oxygen to diffuse into the pulmonary capillary is 104 – 40, or 64 mm Hg.
About 98 percent of the blood that enters the left atrium from the lungs has just passed through the alveolar capillaries and has become oxygenated up to a Po2 of about 104 mm Hg.
Another 2 per cent of the blood which supplies mainly the deep tissues of the lungs and is not exposed to lung air. This blood flow is
called “shunt flow,” meaning that blood is shunted past the gas exchange areas
One gram of Hb can bind 1.34 ml of Oxygen
Normal level of Hb is 15 grams/dL
Thus 15 grams of hemoglobin in 100 milliliters of blood can combine with a total of almost exactly 20 milliliters of oxygen if the hemoglobin is 100 per cent saturated
This is usually expressed as 20 volumes per cent
Hemoglobin is a conjugated protein consisting of heme and globin.
The ferrous form can bind oxygen.
Hemoglobin molecule consists of four subunits each consists of one heme and one polypeptide chain
Each subunit can bind one molecule of Oxygen
Oxygenation is a very rapid and reversible process and it can occur in 0.01 seconds
When PO2 is high, oxygen binds with Hb to form Oxyhemoglbin
When PO2 is low oxygen leaves Hb to form Deoxy Hb.
Factors that shift the oxygen hemoglobin dissociation curve
Urine Acidification is quite a dry and lengthy topic, it's quite hard to keep a track on it's every extrusion and intrusion so here I broke the process in steps. Hope it becomes easy for you :)
By: Paul M. McNeill, M.D.
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Mechanism of Respiration//BREATHING MECHANISM//Gaseous exchange//INSPIRATION ...Wasim Ak
Mechanism of Respiration involves breathing mechanism and exchange of gases (Oxygen and Carbon Dioxide). Breathing mechanism will be continued with Inspiration (Inhalation) and Expiration (Exhalation) .
The nephron is the microscopic structural and functional unit of the kidney. It is composed of a renal corpuscle and a renal tubule. The renal corpuscle consists of a tuft of capillaries called a glomerulus and an encompassing Bowman's capsule. The renal tubule extends from the capsule.
Urine Acidification is quite a dry and lengthy topic, it's quite hard to keep a track on it's every extrusion and intrusion so here I broke the process in steps. Hope it becomes easy for you :)
By: Paul M. McNeill, M.D.
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Mechanism of Respiration//BREATHING MECHANISM//Gaseous exchange//INSPIRATION ...Wasim Ak
Mechanism of Respiration involves breathing mechanism and exchange of gases (Oxygen and Carbon Dioxide). Breathing mechanism will be continued with Inspiration (Inhalation) and Expiration (Exhalation) .
The nephron is the microscopic structural and functional unit of the kidney. It is composed of a renal corpuscle and a renal tubule. The renal corpuscle consists of a tuft of capillaries called a glomerulus and an encompassing Bowman's capsule. The renal tubule extends from the capsule.
Last year by end of the lecture Dr Medinna gave cases to solve for Fluid and electrolytes....
He had a seperate slide for the cases..
Lecture slides are taken from Schwartz Textbook of surgery....
Body fluid & electrolytes........Dr.Muhammad Anwarul Kabir,FCPS(Medicine)kabirshiplu
Body fluid & electrolyte disturbances are one of the critical but commonest problems in our day to day practices.This presentation helps to make a basic ideas dealing with dyselectrolytaemia
2. Fluid compartments
Human body is approximately 60% water
Total body water 42ℓ
Transcellular fluid (7%) 1ℓ
Plasma (23%) 3ℓ
Interstitial fluid (70%) 10ℓ
Intracellular fluid (⅔) 28ℓ Extracellular fluid (⅓) 14ℓ
4. Composition of other fluids
Daily production Na+ K+ Cl- HCO3-
(mℓ) (mmol/ℓ) (mmol/ℓ) (mmol/ℓ) (mmol/ℓ)
Saliva 1000 20-80 10-20 20-40 20-60
Gastric 1000-2000 20-100 5-10 120-160 0
Pancreatic 1000 120 5-10 10-60 80-120
Bile 1000 150 5-10 40-80 20-40
Small bowel 2000-5000 140 20 105 25-50
Large bowel 200-1500 80-140 30 30 60
Sweat 200-1000 20-70 5-10 40-60 16
5. Osmotic concentration
The total concentration of
solutes in a solution
Represents the number of
particles
Measured in osmoles per litre
Colligative properties
Lowering of vapour pressure
Elevation of boiling point
Depression of freezing point
Osmotic pressure
7. Sodium
Primary cation of extracellular fluid
Primary determinant of extracellular
osmolarity
Intimately related to fluid balance
Hypernatraemia causes cerebral
dehydration
Lethargy, weakness, irritability
Twitching, seizures, and coma
Hyponatraemia causes cerebral
oedema
Nausea, malaise, lethargy
Obtundation, seizures, coma
8. Sodium
Hypernatraemia caused by Hyponatraemia caused by
Increased sodium intake Decreased sodium intake
Drinking seawater Increased sodium loss
Intravenous hypertonic Diarrhoea
saline Diuretics
Decreased free water Increased free water
intake intake
Hypodypsia Polydypsia
Increased free water loss Exercise-associated
Sweating, fever hyponatraemia
Diabetes insipidus Decreased free water loss
Osmotic diuresis (glucose, SIADH
mannitol) Advanced renal failure
9. Sodium and water loss
Normonatraemic
hypovolaemia Normal
Loss of sodium and water
Haemorrhage
Burns
Effusion of ECF in body spaces
(ascites) Free
Prone to circulatory collapse water
Hypernatraemic loss
hypovolaemia
Loss of low sodium water
Sweating
Diabetes insipidus
Prone to cerebral Isotonic
dehydration fluid
loss
10. Sodium and fluid homeostasis
Renin-angiotensin-aldosterone system
Low renal perfusion
Increased renin secretion
Angiotensinogen → Angiotensin I
Vasoconstriction
Angiotensin I → Angiotensin II Increased ADH releaseVaso-
constriction
Increased sodium
reabsorption
Increased aldosterone secretion
Increased sodium (water) absorption
11. Sodium and fluid homeostasis
Arginine vasopressin
High osmolarity / Low plasma volume
Increased ADH secretion
Increased thirst
Increased (free) water reabsoption
Vasoconstriction
12. Sodium
Clinical conditions associated with Clinical conditions associated with
hypernatraemia hyponatraemia
Sodium excess Water excess
Inappropriate ADH secretion
High sodium intake Glucocorticoid deficiency
Administration of high sodium Hypothyroidism
containing fluids Psychogenic polydypsia
Condition associated with increased total body sodium
Primary hyperaldosteronsism Heart failure
Water deficiency Liver disease
Renal failure
Burns Nephrotic syndrome
Hyperventilation Sodium deficiency
GIT losses (vomiting, diarrhoea)
Diabetes insipidus Burns
Decreased fluid intake Diuretic therapy
Adrenal insufficiency
Conditions associated with a decreased Salt-losing nephropathy
total body sodium Renal tubular acidosis
Osmotic diuresis Osmotic diuresis
Diabetes mellitus, mannitol infusion Bicarbonaturia, ketonuria
Excessive sweating Transcellular movement
Adrenal insufficiency
Exercise, fever
Sick cell syndrome
GIT losses (vomiting, diarrhoea) Pseudohyponatraemia
Hyperlipidaemia, hyperglobulinaemia
13. Potassium
Predominant intracellular cation
Only 2% of potassium is extracellular [K+] = 4 [K+] = 150
Major role of K+ is to create a membrane K+
potential in excitable cells (nerve, Na+
muscle, β-cells of pancreas)
Plasma potassium negatively regulated
by aldosterone ―
+ CELL
Hypokalaemia hyperpolarises cells -90mV
Muscle weakness
Decreased cardiac excitability, cardiac
arrest
Decreased insulin secretion
Hyperkalaemia depolarises cells voltage-gated
Na channel,
Cardiac arrhythmias, ventricular opens once
fibrillation membrane
potential falls
to -60mV
14. Potassium
Predominant intracellular cation
Only 2% of potassium is extracellular
Plasma potassium is a poor indicator of
body potassium
Major role of K+ is to create a membrane
potential in excitable cells (nerve, muscle,
β-cells of pancreas) Distal convoluted tubule
Hypokalaemia hyperpolarises cells
Muscle weakness
Na+
Decreased cardiac excitability, cardiac ATP
Na+
arrest K+ K+
Decreased insulin secretion
Hyperkalaemia depolarises cells H+
Cardiac arrhythmias, ventricular
fibrillation
Plasma potassium negatively regulated by
aldosterone Tubular
lumen
17. Chloride
Primary anion of extracellular fluid
Intimately associated with sodium
No symptoms directly associated to hyperchloraemia
or hypochloraemia
Hyperchloraemia caused by
Causes of hypernatraemia
Metabolic acidosis
Hypochloraemia caused by
Causes of hyponatraemia
Metabolic alkalosis