methodical recommendations

PHYSIOLOGY OF BLOOD SYSTEM.

UNIT № 1

Topic: Blood system. Blood functions. Leucocytes.

The purpose of the unit: to understand role of the blood, WBCs in the organism.

Questions for Self-Preparation

1. Blood system, its functions. Blood content and volume.

2. Regulation of acid-base balance by the blood. Buffering systems

3. General characteristics of white blood cells (leukocytes). Leukocytosis and leukopenia.

Physiological leukocytosis.

4. WBC differential count (leukogramm). Regenerative and degenerative shift of

leucogramm, clinical application. Role of different types of leukocytes.

5. Genesis of leukocytes. Regulation of WBC production (factors necessary for WBC

production).

Practice

1. Protocol of Taking Blood for Test.

The blood is taken from ring finger since it has separated vagina synovialis. If an

inflammation penetrates into the wound, it does not spread to the whole hand.

The test requires: scarificator, sterile cotton wad, alcohol, and iodine solution.

Observer washes his hands with soap, and puts on the gloves. The Patient sits at the table;

Observer makes disinfection of the ring finger by alcohol. The Observer quickly punctures the

skin of the ring finger end phalanx by scarificator. The puncture must be done rather deep to

cause free bleeding. The Observer removes the first drop of the blood; the next drops are suitable

for analysis. The Observer uses iodine solution for disinfection of the Patient’s finger after

analysis.

2. WBC Total Count.

The test requires: 0.4 ml of 3-5% acetic acid, glass tube, counting chamber, medicine dropper,

and micropipette. 3-5% acetic acid causes hemolysis of erythrocytes for easy calculation of

leukocytes.

Take 0.4 ml of 3-5% acetic acid with dropper and pour it out into the tube. Then take 20 mm3

of blood with micropipette and pour into the tube. Mix the contents of the test tube carefully.

Prepare the counting chamber. Fill the counting chamber with diluted blood. Calculate the

leukocytes in 25 large boxes.

Calculate the WBC total count according to formula: L = (N * 4000 * 20)/400; where L is

number of leukocytes in 1 ml, N is number of leukocytes in 400 small boxes (25 large boxes), 20

is blood dilution.

3. WBC Level after Exercises.

Blood is tested in a patient after certain physical exercises. WBCs are counted according the

same protocol.

4. WBC Differential Count.

White blood cells are calculated in the prepared blood sample. The dry sample is put under

the microscope with the help of immertion lens. Calculate 100 or 200 WBCs and express the

result in percentage.

Literature

Guyton A., Hall J.: Textbook of Medical Physiology. 11/e, 2006. P.: 103-104, 241-242,

266-274.

UNIT № 2

Topic: Plasma proteins, their functions. Protective function of the blood, leucocytes. .

The purpose of the unit: to understand functions of plasma proteins, WBCs in the

organism.


1. Plasma proteins, their functions. Osmotic and oncotic pressure of the blood.

2. Characteristics of red blood cells (erythrocytes).

3. Suspension stability of erythrocytes, sedimentation rate.

4. Haemolysis and fragility. Types of haemolysis.

5. Red blood cells production. Regulation of RBC production (factors necessary for

erythropoiesis).

6. Hemoglobin. Derivatives of hemoglobin, hemoglobin types and forms.

Practice

1. RBC Total Count.

The 3% hypertonic NaCl solution causes shrinking of erythrocytes for their easy calculation.

The test requires: 3% hypertonic NaCl solution, glass tube, counting chamber, medicine

dropper, micropipette.

2

Take 4 ml 3% hypertonic NaCl solution with dropper and pour it into the glass tube. Collect

exactly 20 mm3 of blood with micropipette and add it out into the tube. Shake the test tube and

wait 15 minutes.

Prepare the counting chamber: press the covering glass on the counting chamber until the

bands appear at the edges (this indicates the required height of the camera – 0.1 mm). Fill the

counting chamber with diluted blood. Calculation of erythrocytes is provided on base of the

counting chamber in its 5 large boxes (each divided into 16 small boxes).

Calculate the RBC total count according to the formula: E = (N * 4000 * 200)/80; where N is

number of erythrocytes in 5 large boxes, 1/4000 is volume of small box, 200 is dilution level, 80

is number of small boxes. Make conclusion on RBC total count.

2. Hemoglobin Level Test

The hemoglobin level is determined by calorimetric technique, i.e., by comparing the colors

of test and standard solutions. Sahli’s haemoglobinometer consists of rack with frosted glass and

three test tubes. Two sealed tubes contain colored standard solution which corresponds to

hemoglobin level 16.7 g/dl (167 g/l). In the third graded tube we can test hemoglobin in the

blood.

Test requires: Sahli’s haemoglobinometer, 0.1 N hydrochloric acid solution, distilled water.

Fill the haemoglobinometer tube with 0.1 N hydrochloric acid up to the marked level. Collect

exactly 20 mm3 of the blood with the micropipette and pour it to the bottom of the tube. Flush

the micropipette with the acid. Thoroughly mix the content by shaking. Put the mixture for 5-10

minutes. Then add distilled water drop by drop until the color is similar top standard. Mark the

lower level of the solution on the tube scale: it is hemoglobin level in 1 dl of the blood.

3. Color Index of the Blood.

The color index of the blood (farb-index) characterizes the rate of erythrocytes’ saturation

with hemoglobin. Normal fi is 0.9 to 1.1. The color index of blood is calculated by formula: FI=

(Hb * 3)/E, where FI - the color index of blood, Hb - the hemoglobin level, E – RBC number in

the counting chamber.

4. Erythrocyte Sedimentation Rate (ESR) Test

Sedimentation of the formed elements occurs in noncoagulating blood and results in the

separation of the blood into two layers: the upper is plasma layer, and the lower layer of blood

cells. The rate of erythrocyte sedimentation varies within broad range depending on blood

composition and the state of the organism. The ESR is significantly affected by protein

proportions in plasma, globulin rise in plasma causes ESR increase. The normal rate of

erythrocyte sedimentation is 3 to 7 mm/hr in adult males, 5 to 10 mm/hr in females. ESR

3

increases in some infectious or inflammatory diseases, malignant tumors, and in pregnancy.

ESR decreases in erythrocytosis, typhoid fever, infectious hepatitis, etc.

The ESR is estimated by Panchenkov’s (Westergren’s) device. The device consists of racks

and glass capillary tubes graduated in millimeters (0 to 100 mm, the zero mark is in the upper

portion of the capillary).

The test requires: the Panchenkov’s device, a watch glass, a 5% sodium citrate solution,

blood.

Figure1. The Panchenkov’s (Westergren’s) glass capillary tube.

K – blood level, P – solution level.

Wash capillary tube with sodium citrate and add blood diluted 1:4. Flush the

Panchenkov glass capillary tube with a 5% sodium citrate. Add this solution to the level

marked '50' and blow it out onto the watch glass. Take blood twice to the level marked '0',

then blow the blood onto the watch glass and mix it with sodium citrate solution. Fill the

capillary tube with the citrated blood exactly to level '0' and place the tube into the rack in

a vertical position. In one hour exactly measure plasma layer above the settled blood cells.

Literature

Guyton A., Hall J.: Textbook of Medical Physiology. 11/e, 2006. P.: 237-241, 256-263.

UNIT № 3

Topic: Mechanism of blood coagulation. Blood groups.

The purpose of the unit: to understand the mechanism of blood coagulation, basic principles of

blood transfusion.


1. Mechanism of hemostasis. Clotting factors in the blood.

2. Characteristics of platelets. Mechanisms of the platelet plug formation.

3. Blood coagulation: formation of prothrombin activator: extrinsic and intrinsic pathways

for initiating clotting. Role of calcium ions in the process.

4. Blood coagulation: conversion of prothrombin to thrombin, conversion of fibrinogen to

fibrin. Blood coagulation tests.

5. Intravascular anticoagulants. Anticoagulants for clinical use.

6. Blood groups and blood typing.

7. Rh blood types.

8. Transfusion reactions depending on Rh types and ABO blood types.

4

Practice

1. Bleeding Time.

Bleeding time is determined starting with the ring finger puncture till the stoppage of

bleeding. Normal the bleeding time is up to 4 minutes.

The test requires: scarificator, filter paper, cotton wad, alcohol, iodine solution, and

stopwatch.

The Observer punctures the Patient’s end phalanx of the ring finger by scarificator, then

places filter paper against the puncture point each 30 seconds till bleeding stops. Take the

bleeding time in your Patient.

2. Blood Coagulation Test.

The coagulation time depends on interaction between coagulation system, anticoagulants, and

fibrinolysis. Normal coagulation time is 3-5 minutes (by Dyuka method).

The test requires: paraffined watch glass, glass hook, stopwatch, scarificator, cotton wad,

alcohol, iodine solution.

Observer punctures Patient’s end phalanx of the ring finger by scarificator; takes large drop of

the blood and transfers this drop to the surface of paraffined watch glass. Then Observer moves

the glass hook through blood drop each 30 seconds. Note the time, when fibrin filaments appear

on the hook.

3. a) Standard Sera Blood-Typing

For blood-typing, a small amount of tested blood is added to standard haemagglutinating sera

of 0 (I), A (II), B (III), and AB (IV) groups. The presence of agglutination indicates that

erythrocytes of the specimen contain agglutinogen corresponding to agglutinin antibody of the

standard serum. The absence of agglutination means that the blood specimen is devoid of the

agglutinogen corresponding to the agglutinin contained in the serum.

The test requires: standard haemagglutinating sera of groups 0 (I), A (II), B (III), and AB

(IV), 0.9% sodium chloride solution, glass stick. Blood-typing should be performed in a well-lit

room at 18-24°C.

Apply two drops of each serum group to a porcelain plate (use sera of two series with

different content of agglutinins-antibodies). Apply a small amount of blood to each serum drop

(the quantity of the serum must be about 10 times more). Blood-typing is carried out for 5

minutes by tilting the plate. When the agglutination begins (in at least 3 min), add one drop of

0.9% sodium chloride solution to each test drop and, tilting the plate, observe it for 5 minutes. In

5 minutes observe absence or presence of agglutination in each drop.

5

b) Anti-A and Anti-B Coelyclones Blood-Typing

Coelyclones Anti-A and Anti-B are destined for blood-typing instead of standard

isohaemagglutinating sera. A small amount of tested blood is added to coelyclones anti-A and

anti-B. The presence of agglutination indicates that erythrocytes of the specimen contain

agglutinogen for the anti-A or anti-B antibody of the coelyclones. The absence of agglutination

means that the blood specimen is devoid of the agglutinogen corresponding anti-A or anti-B

antibody.

The test requires: porcelain plate, anti-A and anti-B coelyclones, 0.9% sodium chloride

solution, glass stick.

Apply two drops (0.1 ml) of anti-A and anti-B coelyclones to a sterile porcelain plate. Apply a

small amount of the blood specimen to each drop of coelyclones (the quantity of the coelyclone

must be about 10 times more). Blood-typing is carried out for 2.5-5 minutes by tilting the plate.

In 5 minutes observe absence or presence of agglutination in each drop. If the agglutination is

present (in at least 3 min) in both drops of coelyclones, i.e. blood group is AB (IV), make a

control research of the blood specimen with isoosmotic sodium chloride solution. Apply one

drop (0.1 ml) of 0.9% sodium chloride solution to sterile porcelain plate and add a small amount

(0.01 ml) of blood to. Mix the drops and tilt the plate for 2.5-5 minutes. If the agglutination is

absent in this control blood group is AB (IV).

4. Rhesus Factor Blood Typing

Apply two drops of anti-rhesus standard serum to porcelain plate. Add small amount of blood

and mix. Tilt the plate from one side to other and observe the result in 5 minutes. The presence

of agglutination indicates the Rh-positive blood and the absence of agglutination indicates the

Rh-negative blood.

Literature

Guyton A., Hall J.: Textbook of Medical Physiology, 11/e, 2006. P.: 275-290

Questions for Colloquium

1. Blood system, its functions. Blood plasma. Plasma proteins. Osmotic pressure. Oncotic

pressure.

2. Blood buffering system. Regulation of acid-base balance in the blood.

3. Characteristics of red blood cells (erythrocytes). Suspension stability of erythrocytes,

sedimentation rate.

6

4. Production of red blood cells. Stages of differentiation of red blood cells. Factors which

control red blood cell production.

5. Destruction of red blood cells, haemolysis and fragility. Types of haemolysis.

6. Hemoglobin. Derivatives of hemoglobin, types of hemoglobin, abnormal hemoglobin.

7. General characteristics of white blood cells (leukocytes). Leukogramm. Regenerative shift

of leucogramm and degenerative shift of leucogramm.

8. Role of different types of leukocytes.

a. Neutrophils main functions, phagocytosis. Types of neutrophils.

b. Eosinophils, mechanism of action.

c. Basophils, mechanism of action.

d. Monocyte-macrophage system, role in the organism.

e. Lymphocytes, role in the organism.

9. Leukocytosis. Different types of leukocytosis. Leycopenia.

10. WBC production. Factors which controlleukocyte production.

11. Characteristics of platelets. Mechanisms of platelet plug formation.

12. Clotting factors in the blood. Role of calcium ions in blood clotting.

13. Formation of prothrombin activator: extrinsic and intrinsic pathways for initiating clotting.

14. Mechanism of blood coagulation: conversion of prothrombin to thrombin, conversion of

fibrinogen to fibrin. Blood coagulation tests.

15. Intravascular anticoagulants. Anticoagulants for clinical use.

16. Blood groups and blood typing. Rh blood types.

17. Transfusion reactions depending on Rh types and ABO types.

PHYSIOLOGY OF RESPIRATORY SYSTEM.

UNIT № 1

Topic: Respiratory system. Gas exchange.

The purpose of the unit: to study biomechanics of air inhalation and exhalation, mechanisms of

gases exchange.


1. Functions of the respiratory system. Non-gas exchange functions of the lungs.

2. Mechanics of pulmonary ventilation.

3. Movement of air in and out of the lungs. Pleural, alveolar, and transpulmonary pressures.

Fluids in the pleural cavity.

7

4. Surfactant, alveolar surface tension, and collapse of the alveoli. Pneumothorax, changes of

respiration during pneumothorax.

5. Pulmonary volumes and capacities.

6. Gas exchange. “Partial pressure” of individual gases. Composition of alveolar air. Oxygen

and carbonic dioxide concentration and partial pressure in alveoli.

7. Diffusion of gases through the respiratory membrane.

Practice

1. Biomechanics of Inhalation and Exhalation on the Donders’s Model.

Model of the thoracic cavity consists of glass dome with rubber membrane covering its

bottom. The rabbit lungs are located inside the glass dome, which plays the role of immobile

parts of the thoracic cavity; rubber membrane plays the role of the diaphragm.

If you pull rubber membrane downwards, volume of "thoracic cavity" increases as in the case

of inhalation. If you press the rubber membrane inside the dome, the volume of the "thoracic

cavity" decreases as in the case of active exhalation.

2. Spirometry.

Spirometry is the methodic to determine vital capacity and lung volumes.

Tidal volume (TV). Patient makes normal inhalation and exhalation through the spirometer

five times. Take the volume of air at the scale of spirometer; divide the taken result into 5 to

determine the tidal volume. Normal TV approximately equals 500 ml.

Vital capacity (VC) of the lungs is the greatest amount of the air, which Patient can exhale out

forcefully after the deepest inspiration. Vital capacity includes inspiratory reserve volume (IRV),

tidal volume (TV), and expiratory reserve volume (ERV). Patient makes deep inhalation and

then deep exhalation through spirometer. Determine the vital capacity at the scale of spirometer.

The normal VC value: in males 3500-4900 ml, in females 2800-4000 ml.

Expiratory reserve volume (ERV). Patient makes normal exhalation and then the deepest

exhalation through spirometer. Determine ERV at the scale of spirometer. Repeat this test three

times and then calculate the ERV average value. Normal value is around 1000 ml.

Inspiratory reserve volume (IRV). Inspiratory reserve volume is calculated by formula IRV =

VC-(TV+ERV), where IRV – inspiratory reserve volume, VC – vital capacity, TV – tidal

volume, ERV – expiratory reserve volume.

Inspiratory capacity (IC). The inspiratory capacity is calculated by formula IC= TV + IRV,

where IC – inspiratory capacity, TV – tidal volume, IRV – inspiratory reserve volume.

8

3. Spirography.

Spirography is the methodic which registries lung volumes, respiration rate, depth of

respiration, and respiratory minute volume (RMV).

Patient breathes through the bite-board of spirograph during one minute, then he/she makes

deep inhalation and deep exhalation through spirograph. Calculate tidal volume, inspiratory

reserve volume, expiratory reserve volume, respiration rate (RR), respiratory minute volume

RMV = TV (tidal volume)*RR; on the base of spirogram.

4. Pneumotachometry.

Pneumotachometry is the methodic to determine air peak flow during forced inspiration and

forced expiration. These data indicate the force of inspiration or expiration and conductivity of

the respiration passageways.

The test requires: pneumotachometer, cotton wad, alcohol.

To check up force of inspiration Patient makes deep exhalation and then forced inspiration

through the sensor part of pneumotachometer. To check up force of expiration Patient makes

deep inhalation and then forced expiration through the sensor part of pneumotachometer. Repeat

each procedure 5 times. The force of inspiration or expiration is defined by maximum indications

on pneumotachometer.

Literature


UNIT № 2

Topic: Diffusion of gases. Regulation of respiration.

The purpose of the unit: to understand mechanisms of the respiratory center activity.


1. Diffusion of gases in the lungs and tissues.

2. Transport of oxygen in the blood. Oxyhemoglobin saturation- dissociation curve and

factors that influence it.

3. Transport of carbon dioxide in the blood, role of carbonic anhydrase.

4. Regulation of respiration. Respiratory center.

5. Chemical control of respiration.

6. Regulation of respiration during exercise.

7. Changes in respiration at high altitude and deep-water.

9

Practice

1. Low Barometric Pressure Effect on the Mouse Organism.

A white mouse and height-meter are put under isolated glass dome of the Kamovski pump. At

the beginning of the experiment you pump-out air from the glass dome gradually. Pay attention

on the animal behavior, rhythm and rate of its respiration compared to the height indication.

The first stage of hypoxemic hypoxia: you may observe tachypnoe as the result of oxygen

partial pressure decrease in inspired air. The animal becomes anxious.

The second stage of hypoxia: hypopnoe and Cheney-Stokes’ respiration as the result of

carbon dioxide partial pressure decrease in the blood due to increased pulmonary ventilation. It is

the vicious circle: hypoxia first results in the hyperactivity of the respiratory center then it results

in the deficient activity of the respiratory center, the respiratory failure later it aggravates

hypoxia. Coordination of movements is out of order. The hair gets up and becomes moist,

mucous becomes cyanotic.

The third stage of hypoxia: the animal takes the lateral position. The respiration becomes

abrupt, broken, and spasmodic. The animal is perishing as a result of respiratory center paralysis

and vasomotor center paralysis.

Literature


PHYSIOLOGY OF METABOLISM, THERMOREGULATION.

UNIT № 1

Topic: Dietary balances. Energetic and metabolic rates.

The purpose of the unit: to understand energetic and metabolic rates in the human

organism.


1. Dietary balances. The average daily requirement for nutrient.

2. Regulation of food intake: short-term regulation and long-term regulation.

3. Energetic and metabolic rate.

4. Basal metabolic rate and influence factors on BMR. Methods to study BMR.

5. Energy required for different activities. TMR, overall energy requirement for daily

activities.

10

6. Body temperature. Heat production and heat loss.

7. Regulation of body temperature: conduction, convection, and radiation.

Practice

1. Calculation of Predicted Basal Metabolic Rate.

Calculation of the average level of predicted basal metabolism is based on the special table

according to the growth, body weight, age, and sex of a Patient. The basal metabolism is

different for males and females, BMR in males is 10% higher than in women.

The test requires: auxanometer, scales, and tables for BMR determination.

Take Patient’s height and weight. For example: Patient is 25 years old male, 168 cm high,

and weight is 60 kg. You must find the weight 60 kg in the vertical column of the table and you

see near it 892 Calories. In horizontal column of the table you must find age 25 years. In vertical

column of the table you must find the height 168 cm. At the corsage of lines you must find the

next data – 672 Calories. Sum up 892+672=1564 and get the normal level of basal metabolism

(average statistical value) for this Patient - 1564 Calories.

Tables for calculation basal metabolism in males and females

Table for basal metabolism calculation in malesWeight (kg)

Calorie Weight (kg)

Calorie Weight (kg)

Calorie Height (cm)

Age in years17 19 21 23 25 27 29

47484950515253545556575859606162

713727740754768782795809823837850864878892905919

63646566676869707172737475767778

93394796097498810021015102910431057107010841098111211251139

79808182838485868788899091929394

1158116711801194120812221235124912631277129013041318133213451359

140144148152156160164168172176180184188192196200

553593633673713743773803823843863883903923--

528568608648678708738768788808826848868888908-

---619639659679699718739759779799819839859

---605625645665685705725745765785805825845

---592612631652672692718732752772792812832

---578592618638658678698718738758778798818

---563583605625645665685705725745765785805

Table for basal metabolism calculation in femalesWeight (kg)

Calorie Weight (kg)

Calorie Weight (kg)

Calorie Weight (kg)

Calorie Height (cm)

Age in years17 19 21 23 25 27 29

11

474849505152535455565758

110511141124113311431152116211721181119112001210

596061626364656667686970

121912291238124812591267127712801296130513151325

717273747576777879808182

133413441353136313721382139114011411142014301439

838485868788899091929394

144914581468147814871497150615161525153515441554

144148152156160164168172176180184188

171187201215229243255267279291303313

162178192206220234246258270282294250

--183190198205213220227235242250

--174181188196203211218225233240

--164172179186194201209218223231

--155162170177184192199207214221

--146153160168175188190197204215

2. Deviation of the Basal Metabolism (by Rid’s Formula).

Rid’s formula helps to calculate the deviation of the basal metabolism from standard level,

basing on the correlation between the blood pressure, heart rate and energy production.

The percentage of BMR deviation is calculated by Rid’s formula:

PD=0.75*(HR+PP*0.74)-72, where PD - percentage of deviation of the basal metabolism

from standard level, HR - hart rate, PP - pulse pressure (PP = Systolic BP – Diastolic BP).

3. Composition of Dietary Intake.

The purpose of the work: to understand the principle of composition of dietary intake for

different groups of population. Test requires: the tables of food chemistry and calorie content.

The food must be efficient, i.e. the food serves the needs of the organism in nutrients and

energy to maintain normal activity of vital organs, working capacity, and proper growth and

development (for children and teenagers). Physiological standards for nutrition depend on age,

sex, height and weight of the Patient, kind of his/her work, and climate. There are four categories

of the energy consumption for adult people depending on the kind of their activities.

Group Kind of work Energy consumption, Calories daily

I Mental work: scientists, physicians, engineers, teachers and others

2100-2450

II Mechanical work: turners, milling-machine operator, textile-worker, car-driver and others

2500-2800

III Manual work or partial mechanical work: metalworker, collective farmer and others

2950-3300

IV Hard manual work: loaders, diggers and others. 3400-4200

The organism needs food containing proteins, lipids, and carbohydrates in the definite ratio.

Group Nutrients, gram/dayproteins lipids carbohydrates

I 109 106 433II 122 116 491

12

III 141 134 558IV 163 153 631

Dietary intake calculation is based on special tables, which show content of proteins, lipids,

carbohydrates and energy in different foods.

The best dietary habits – eating four times a day. First breakfast must contain 25 - 30% of

daily energy and nutrients, second breakfast - 10-15%, lunch - 40 - 45% and dinner- 15 - 20%. It

is better to take protein rich food (meat, fish, and eggs) for breakfast and lunch. For dinner dairy

products and vegetable are more suitable. Food must have animal proteins and lipids (no less

than one third of the volume), vitamins, mineral salts, and water.

Write down your own dietary balance to the table.

The dietary habits

The name of

foodstuffs

The weight in gram

The contents of foodstuffs in gram Calorie contentprotein lipid carbohydrate

First breakfastSecond

breakfastLunch

Dinner

Total amount

Literature



1. Functions of the respiratory system. Non-gas exchange functions of lungs.

2. Mechanics of pulmonary ventilation.

3. Movement of air in and out of the lungs. Pleural, alveolar, and transpulmonary pressures.

4. Surfactant, surface tension, and collapse of the alveoli. Pneumothorax, changes of

respiration during pneumothorax.

5. Pulmonary volumes and capacities.

6. Gas exchange. “Partial pressures” of individual gases. Composition of alveolar air.

7. Diffusion of gases in the lungs and tissues.

8. Transport of oxygen in the blood. Oxygen-hemoglobin dissociation curve and factors

that influence it.

9. Transport of carbon dioxide in the blood. Carbon dioxide dissociation curve.

13

10. Regulation of respiration. Respiratory center.

11. Chemical control of respiration.

12. Regulation of respiration during exercise.

13. Changes in the body at high altitude and deep-water.

14. Dietary balances. The average daily requirement for nutrient.

15. Regulation of food intake: short-term regulation and long-term regulation.

16. Basal metabolic rate and influence factors on BMR. Methods of investigation BMR.

17. TMR, energy used for physical activities. Overall energy requirement for daily activities.

18. Body temperature. Heat production and heat loss.

19. Regulation of body temperature: conduction, convection, and radiation.

GASTROINTESTINAL PHYSIOLOGY

UNIT № 1

Topic: General principles of gastrointestinal functions; GIT functions and their regulation;

digestion in the mouth and in the stomach.

The purpose of the unit: to acquaint with methods of digestion research.


1. Hunger and satiety. Neural centers regulate food intake.

2. Functions of gastro-intestinal tract.

3. Ingestion of food. Mastication. Deglutition, stages of deglutition.

4. Food movement in the esophagus.

5. Secretion of saliva. Nerve regulation of saliva secretion.

6. Functions of the stomach. Properties and composition of gastric juice.

7. Mechanism of gastric juice secretion. Phases of gastric juice secretion.

8. Nerve and hormone control of gastrointestinal functions. Regulation of gastric secretion.

9. Gastric motility. Control of stomach emptying.

Practice

1. Gnatodinamometry.

Patient keeps the sensor part of gnatodinamometer in frontal teeth and strongly presses his

jaws. Determine the maximum force of chewing muscles contraction. Repeat this experiment for

molar teeth. Put the data of the experiment to the table.

14

The maximum strength of mastication (kg)In frontal teeth region In molar teeth region

2. Masticaciography.

Put rubber cuff on Patient’s mandible and fix it. Blow up the cuff with air through a tube.

Register jaw movements while chewing different food. Mark the following phases: initial phase,

phase of receiving food, phase of appreciate chewing, the main phase of the chewing, phase of

bolus formation.

Literature

Guyton A., Hall J.: Textbook of Medical physiology. 11/e, 2006. P.: 537-543, 546-551, 556-

564, 584-586.

UNIT № 2

Topic: Digestion in the small intestine and the colon; absorption in the small intestine.

The purpose of the unit: to study the participation of different parts of GI tract in various foods

digestion.


1. Pancreas secretion, the pancreatic digestive enzymes.

2. Regulation of pancreatic secretion. Phases of pancreatic secretion.

3. Bile secretion. Composition and functions of bile. Emptying of the gallbladder.

4. Functions of small intestine. Secretion in small intestine. Digestion of various foods.

5. Basic principles of gastrointestinal absorption. Absorption of water, ions and nutrients

in small intestine.

6. Movements of small intestine. Mixing contractions and peristalsis.

7. Function of large intestine. Absorption in large intestine. Movements of the colon.

Practice

1 Absorption in Small Intestine of Rat.

Start the operation of intestinal loop separation: cut skin, muscles and peritoneum

consecutively along the white line, select the small intestine loop; ligate 2-3 cm segment.

Introduce cannulae into distal and proximal parts, fix them with ligatures. Wash the chosen

15

intestinal loop with distilled water. Fill the insulated segment with isotonic solution. Mark the

level of fluid in the burette; observe its change in 15 minutes. Repeat the experiment, using

hypertonic and hypotonic solutions. Put the results to the table.

Solution Absorption time Volume (ml)Hypotonic 15 minIsotonic 15 min Hypertonic 15 min

Literature

Guyton A., Hall J.: Textbook of Medical physiology. 11/e, 2006. P: 551-555, 564-581.

RENAL PHYSIOLOGY AND EXCRETION

UNIT № 1

Topic: Urine formation by the kidneys. Micturition.

The purpose of the unit: to study the role of excretory system in homeostasis.


1. Organs of excretion, their functions.

2. Multiple functions of the kidneys in homeostasis.

3. Physiological anatomy of the kidneys. Renal blood supply. Nephron as functional unit of

the kidney.

4. Stages of urine formation: glomerular filtration. Glomerular capillary membrane.

Determinants of the glomerular filtration rate.

5. Stages of urine formation: reabsorption and secretion by the renal tubules. Passive and

active mechanisms of tubular reabsorption.

6. Reabsorption and secretion along different parts of nephron. Solute and water transport in

the loop of Henle.

7. Clearance methods to quantify kidney function.

8. Physiological control of glomerular filtration and renal blood flow. Regulation of tubular

reabsorption, its hormone control.

9. Filling of the urinary bladder. Micturition reflex. Higher centers for micturition control.

Practice

16

1. Influence of Exercises and Temperature on Sweating.

Two students paint both palms with Minor solution and powder them with starch. Some time

later blue dots appear in places of sweat secretion. Count the number of blue dots within 1 square

centimeter of the palm skin.

Then ask one student to do 20 squatting with his palms open. Observe changes in number of

blue dots on the palm and intensity of their color after exercises.

Ask the other student has to put one palm to container with warm water (60-65С0) and the

other palm to cool container (15-20С0). Observe changes in number of active sweating glands

and intensity of dot coloration in both cases.

Literature

Guyton A., Hall J.: Textbook of Medical physiology. 11/e, 2006. P.: 173-205


1. Gastrointestinal functions: movement of food, secretion, absorption, digestion of food.

2. Hunger and satiety centers of the hypothalamus. Factors that regulate quantity of food

intake.

3. Nerve control of gastrointestinal functions. Enteric nervous system. Autonomic control of

gastrointestinal tract. Hormone control.

4. Ingestion of food. The mechanics of ingestion: mastication, swallowing. Stages of

swallowing, their nerve control.

5. Secretion of saliva. Nerve regulation of saliva secretion. Function of saliva for oral

hygiene.

6. Food movement in the esophagus.

7. Motor function of the stomach. Basic bioelectrical rhythm of the stomach. Regulation of

stomach emptying.

8. Gastric secretion, basic mechanism of hydrochloric acid formation and secretion.

Secretion of pepsinogen and mucus.

9. Phases of gastric secretion. Regulation of gastric secretion by nerve and hormone

mechanisms.

10. Pancreatic secretion. The pancreatic digestive enzymes. Regulation and phases of

pancreatic secretion.

11. Bile secretion. Composition of bile. Storage and concentration of bile in the gallbladder.

12. Functions of bile salts in fat digestion and absorption. Liver secretion of cholesterol.

17

13. Secretion in the small intestine. Digestive enzymes. Regulation of small intestine

secretion.

14. Movements of the small intestine. Propulsive and mixing movements. Peristaltic reflex

and the “law of the gut”.

15. Gastrointestinal absorption. Absorption of nutrients in the small intestine.

16. Digestion in the colon. Movements of the colon. Secretion and absorption in the large

intestine.

17. Multiple functions of the kidneys in homeostasis.

18. Glomerular filtration: composition of the glomerular filtrate. Glomerular capillary

membrane.

19. Physiological control of glomerular filtration and renal blood flow.

20. Reabsorption in renal tubules. Passive and active mechanisms.

21. Reabsorption and secretion along different parts of the nephron.

22. Regulation of tubular reabsorption.

23. Usage of clearance methods to quantify glomerular filtration rate, renal plasma flow,

tubular reabsorption or secretion.

24. Filling of the urinary bladder. Micturition reflex. Higher centers for micturition

CARDIO-VASCULAR PHYSIOLOGY

UNIT № 1

Topic: Physiological properties of the heart muscle; regulation of heart pumping.

The purpose of the unit: to study the heart function and different mechanisms of their

regulation.


1. Properties of the heart muscle: excitability, conductivity, contractility, automatism, etc.

2. Action potential in cardiac muscle. Plateau in the action potential. Refractory period of

the heart.

3. Rhythmical excitation of the heart. Conductive system of the heart. The sinus node as the

pacemaker of the heart. Velocity of nerve impulse conduction in cardiac muscle.

4. Regulation of heart pumping. Intrinsic heart regulation, the Frank-Starling mechanism.

5. Control of the heart by the sympathetic and parasympathetic nerves.

6. Effect of different factors on the heart function (ions, temperature, hormones).

18

Practice

1. Registration of Normal Frog’s Cardiogram.

Destroy the brain and the spinal cord of a frog. Put it down on the special rest. Dissect the

chest and open the frog’s heart. Fix the heart in miograph with clamp. Register the graph of heart

contractions with help of kymograph. Mark systole of atria, systole of ventricles and the diastole.

2. Experiment with the Stannius’ Ligatures.

On the base of cardiogram registration take the heart rate in the frog. Place consecutively three

ligatures upon the frog’s heart. Place the first ligature in the atrium region and tighten it. This

ligature separates SA node from the other parts of the heart. In this case the heart doesn’t

contract. Don’t take the first ligature off. The second ligature is stimulating one. Place it between

the atria and ventricles and don’t tighten it. The heart contracts again. Take the rate of these

contractions. Place the third ligature and separate the apex from other part of ventricle. You can

observe absence of contraction in the apex. Make your conclusions about gradient of heart

automatism. Draw a scheme of conductive system of the heart and places where Stannius’

ligatures are located.

3. Myocardium Excitability in Periods of Cardiac Cycle.

While registration of normal cardiogram, apply superthreshold stimulus to SA node during the

diastole period. You can observe atrial extrasystole. Then stimulate AV node. You can observe

ventrical extrasystole followed by compensatory pause. Mark atrial and ventricular extrasystoles,

compensatory pause on the graph. Make your conclusions about the nature of compensatory

pause.

4. Effect of Vagosympathetic Trunk Stimulation on the Heart Rate.

Take the heart rate of the frog. During registration of normal cardiogram stimulate the

vagosympathetic trunk that innervates the heart (frequency of stimulation is about 30 Hz). Take

the heart rate after stimulation and compare it with the initial data. Increase the force of

stimulation until heart contractions stop. Then continue stimulation till heart rhythm appears

again. Make your conclusions.

5. Hormone Regulation of the Heart Activity.

During registration of cardiogram of the frog consecutively apply solutions of Ca2+, K+ and

epinephrine on the heart. Wash the heart with physiological solution after each application.

19

Observe cardiogram and heart rate changing in each case. Make your conclusions about hormone

influence on the heart rate and amplitude of muscle contraction.

6. Goltz’s Experiment.

Open the heart of the frog. Take the heart rate. Then strike frog’s belly with forceps. Observe

the reaction of heart. If heart contractions stop, fix the time of stoppage. Take the heart rate after

reflex. Describe the scheme of the reflex arch.

7. Danini-Ashner’s Experiment.

Take your heart rate. Neatly push on your closed eyes for 10 seconds. Compare the heart rate

after this influence. The usual reaction is heart rate decrease.

Literature

Guyton A., Hall J.: Textbook of Medical physiology. 11/e, 2006. P.: 24-25, 56-72

UNIT № 2

Topic: Blood and lymph circulation.

The purpose of the unit: to study mane factors of blood circulation; role of these factors in

different parts of the vascular system; regulation of the circulation.


1. Physical base for blood circulation. Basic theory of circulation.

2. Relationships in pressure, flow and resistance. Vascular distensibility and vascular

compliance.

3. Veins and their functions. Venous valves and “venous pump”. Blood reservoir function

of veins.

4. Microcirculation and capillary system. Capillary fluid exchange.

5. Lymphatic system. Formation of lymph. Rate of lymph flow.

6. Local control of blood flow according tissue needs. Long-term blood flow regulation.

7. Hormone regulation of the circulation.

8. Local blood flow: coronary, cerebral, splanchnic, cutaneous, skeletal muscle circulation.

Practice

20

1. Blood Circulation in Swimming Web of a Frog.

Place frog’s swimming web over the hole in the special plate for proper light passage. Observe

blood and lymph microcirculation; it is possible to distinguish erythrocyte movement in blood

capillaries and lymph movement in lymphatic capillaries.

2. Capillaroscopy of Nail Bed Area.

Put a drop of Vaseline oil on nail bed surface. Place capillaroscope tube in vertical position.

Direct the lens to the nail cuticle fold and examine the capillary form (the comma shape, the drop

shape, twisted forms, etc.) and give characteristics to the blood stem (unceasing, intermittent,

propulsive, etc.).

Literature

Guyton A., Hall J.: Textbook of Medical physiology. 11/e, 2006. P.: 80-89, 92-117, 154-157,

304-310, 529-531, 543-544, 601.

UNIT № 3

Topic: Arterial and venous blood pressure.

The purpose of the unit: to study standard units of arterial blood pressure and methods to

measure blood pressure; rapid control and long-term regulation of arterial blood pressure.


1. Blood pressure. Standard units of pressure. Effects of pressure on vascular resistance and

tissue blood flow.

2. Arterial pressure pulsations. Transmission of pressure pulses to the peripheral arteries.

Sphygmography.

3. Clinical methods to measure systolic and diastolic pressure.

4. Nerve regulation of the circulation, role of the autonomic nervous system.

5. Role of central nervous system in rapid control of arterial blood pressure.

6. Long-term regulation of arterial blood pressure. Hormone mechanism of blood pressure

regulation. Role of the kidneys. Rennin-angiotensin system.

7. Local mechanism for regulation of blood pressure.

8. The integrated, multifaceted system for arterial pressure regulation.

9. Venous pressure, variations in venous pressure. Factors regulating venous pressure.

Practice

21

1. Measurement of the Blood Pressure in Man with Indirect Methods.

In medical practice blood pressure is measured by sphygmomanometer. Patient may be either

lying down or sitting with his/her arm at the level of the heart, no clothing constricting the arm.

1. Palpative method by (Riva-Rocci, 1986).

Wrap the cuff around the arm keeping its lower edge about 3 cm above the bend of the elbow.

Slightly press the radial artery at the wrist. Inflate air into the cuff to stop artery pulse. Reduce

pressure in the cuff gradually; note the level where radial pulse just reappears - it is systolic

pressure.

2. Auscultative method (by Korotkoff, 1905).

Wrap the cuff around the arm. Place stethoscope over the cubital space. Inflate the cuff and

raise the pressure to about 23-30 mm more than systolic level determined by palpative method.

Decrease the cuff pressure gradually until the first sound is heard. Record the reading at this

point which marks the systolic pressure. Decrease pressure further and listen carefully to sounds.

Manometer reading at the point when sounds become muffled and disappear marks the diastolic

pressure. Deflate the cuff quickly to zero pressure. Put all the data into the table.

Palpative systolic pressure

Auscultative method

Systolic pressure (SP)

Diastolic pressure (DP)

Pulse pressure PP=

SP-DP

Mean arterial pressure MAP = DP+1/3*PP

#1 Reading 1

Reading 2

Reading 3

Average

#2…….

#3…….

2. Sphygmography.

Ask your Patient to lie on a couch face up. Take pulsation of his/her common carotid artery.

Place the mechano-electrical transducer of Sphygmograph device at the pulsation point. Record

sphygmogram. Mark main parts on the graph: anacrote, katacrote, dicrotic notch and incisure.

Literature

Guyton A., Hall J.: Textbook of Medical physiology. 11/e, 2006. P.: 84-85, 87, 89-92, 118-132,

134-136, 140-141

22

UNIT № 4

Topic: Methods to study heart functions.

The purpose of the unit: to study physiologic base of electrocardiogram, phonocardiogram; to

study pumping of the heart.


1. Cardiac cycle. Diastole and systole. Function of atria, ventricles and valves. Cardiac

cycle of the left ventricle.

2. Pressure changes during cardiac output.

3. Normal values for cardiac output. Cardiac output control.

4. Measurement of cardiac output.

5. Normal electrocardiogram, its characteristics. Relationship of ECG to the cardiac cycle.

6. Methods to register electrocardiogram. ECG leads.

7. Heart valves and heart sounds. Relationship of the heart sounds to the cardiac cycle.

Phonocardiography.

Practice

1. Determination of Stroke Volume (SV) and Cardiac Output (CarO) by Starr’s Method.

The stroke volume is the amount of blood pumped out of each ventricle per beat. The output of

the heart per unit time is the cardiac output. Variations in cardiac output depend on changes in

heart rate or stroke volume. Both positions are controlled by regulation mechanisms. Take blood

pressure and heart rate in your Patient. Calculate SV using the Starr’s formula:

SV (ml) = 100 + 0.5PBP – 0.6DBP – 0.6Ag

where: PBP – pulse blood pressure, DBP – diastolic blood pressure, Ag – age, complete years.

CarO is calculated by using the following formula:

CarO (l) = HR (bpm) * SV (ml)/1000

where HR – heart rate (beats per minute).

To compare the obtained value of CarO to predicted individual value use the formula:

Individual CarO predicted (l) = BMR / 422

BMR was determined in the topic Metabolism on the base of Garris-Benedict’s tables.

Repeat calculations of SV and CarO, based on the results after 30 seconds exercises (20 knee-

bends).

2. Analysis of Physical Working Capacity by Calculation Cardiac Chronotropic Reactivity

Index (Ruffye’s Index).

23

Take Patient’s heart rate in resting state for 15 seconds (HR1Then take HR2 just after exercises

and HR3 during next 15 seconds. Calculate cardiac chronotropic reactivity index (Ruffye’s

index):

RI = [4 (HR1 + HR2 + HR3 – 200)]/10

If the result value is less than 3 – the physical working capacity is excellent; varies from 4 to 6 –

good result; from 7 to 9 – average; from 10 to 14 – satisfactory; is 15 or higher –unsatisfactory.

3. Registration of Electrocardiogram.

ECG is methodic to record electrical activity of the heart. Electrodes are placed on the skin and

fixed. Start registration of electrocardiogram using bipolar type of leads (Syn: Standard leads,

Limb leads). Both electrodes record electrical activity at their respective locations and represent

difference in potentials between two limbs.

Ask your Patient to lie down on the coach comfortably and fully relaxed. You have to put

electrode leads to the body surface of a Patient. Electrode marked red must be placed on the right

arm, yellow one – on the left arm just above wrists. Black electrode is always applied to the right

leg and green one on the left leg just above ankles.

Provide calibration of electrocardiograph (voltage and time). Standard voltage calibration is

1mV/ 1sm; there may be different velocity of paper movement – 25 mm/s and 50 mm/s.

Record ECG in Leads I, II, III; and then in Lead II once more, after exercises.

4. Analysis of Electrocardiogram.

Analyze a sample of ECG, recorded in Lead II. Mmeasure each wave amplitude and duration

and some segment (or interval) duration. The ECG paper is divided into one millimeter squares

by thin lines. Horizontally, one millimeter represents 0.04 second if the speed of moving paper is

25 mm/sec; vertically, one millimeter represents 0.1 mV amplitude. Put the results in the table

and compare it with normal data.

Parameters of

ECG

Normal

amplitude, mV

Registered

amplitude, mV

Normal

duration, sec

Registered

duration, sec

P wave 0.25 0.08-0.11

P-R interval - - 0.16-0.18

Q wave 25% R wave 0.02-0.04

R wave 0.6-1.6 - -

S wave 0.06-0.1 0.02-0.04

QRS complex 2.3 (RI+SIII) 0.06-0.09

24

ST segment - - 0.28-0.44

T wave 0.25-0.5

5. Registration of Phonocardiogram.

PhCG is methodic to record sound phenomena during heart activity. Sounds and murmurs

associated with changes of valve positions and turbulent blood flow in ventricle systole can be

recorded at different points on the chest (according to valves projection) by microphone.

Record the PhCG at standard points on the chest:

Mitral valve – fifth intercostals space, midclavicular line;

Tricuspidal valve – fourth intercostals space on the right of sternum;

Pulmonic valve – second intercostals space on the left of sternum;

Aortic valve - second intercostals space on the right of sternum.

Use PhCG sample for analysis. Calculate mechanical systole of the heart – from the beginning

of Lab sound to the end of Dub sound.

Literature

Guyton A., Hall J.: Textbook of Medical physiology. 11/e, 2006. P.: 60, 62, 73-78, 142-145,

151-153, 165-167


1. Properties of the heart muscle.

2. Excitability of the heart. Action potential in the heart muscle.

3. Excitatory and conductive system of the heart.

4. Cardiac cycle. Ventricular pumping.

5. Intrinsic heart regulation. The Frank-Starling mechanism and other mechanisms of

intrinsic regulation.

6. Nerve (sympathetic and parasympathetic) and hormone control of heart rhythm and

pumping function.

7. Methods to study heart functions. Measurement of cardiac output.

8. Characteristics of normal electrocardiogram.

9. Methods for recording electrocardiogram. ECG leads.

10. Phonocardiography. Origin of normal heart sounds.

11. Functional parts of the circulation. Their characteristics (volume of blood, pressure level,

velocitie of blood flow).

12. Blood pressure, methods to measure.

25

13. Arterial pressure pulsation. Transmission of pressure pulse in arteries. Sphygmography.

14. Veins’ functions. Venous pressure, effect of gravitation on the venous pressure.

15. Microcirculation and capillary system. Vasomotion.

16. Lymphatic system, its functions. Rate of lymph flow.

17. Nerve control of the circulation, role of the autonomic nervous system.

18. Role of the central nervous system in rapid control of arterial blood pressure. Pressor and

depressor reflexes.

19. Long-term regulation of arterial blood pressure. Role of the kidneys. Rennin-angiotensin

system.

20. Local control of blood flow in response to tissue needs. Long-term blood flow regulation.

21. Hormone regulation of the circulation.

22. Local mechanism for regulation of blood pressure.

23. Coronary, cerebral, splanchnic, cutaneous, skeletal muscle circulation.

26

methodical recommendations

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