Unit HUMAN PHYSIOLOGY

HUMAN PHYSIOLOGY - MOD. 3

Code	GP005578
Location	PERUGIA
CFU	2
Teacher	Vito Enrico Pettorossi
Teachers	Vito Enrico Pettorossi
Hours	24 ore - Vito Enrico Pettorossi
Learning activities	Base
Area	Funzioni biologiche integrate di organi, sistemi e apparati umani
Academic discipline	BIO/09
Type of study-unit	Obbligatorio (Required)
Language of instruction	Italian
Contents	Principles of hemodynamics. excitability of the heart. Electrocardiogram. Cardiac mechanic Control mechanisms of cardiac activity Physiology of arterial system. Physiology of microcirculation and lymphatic system. Control of arterial pressure Physiology of venous system Physiology of district circulation
Reference texts	Conti Fisiologia Medica Vol 2. edi-ermes Gayton & Hall Fisiologia Medica Edises Berne & Levy Fisiologia Casa Editrice Ambrosiana
Educational objectives	Knolewdge about functions and regulatory mechanisms of Cardio-vascular system.
Prerequisites	In order to be able to understand the topics of the teachings at the beginning of the course the student must have the knowledge about the previous teachings and in particular: knowledge about the hunam anatomy. Important knowledge of biochemistry. Important knowledge of gebneral physics. Important
Teaching methods	Teaching is organized through: 20 hours of face-to-face lessons on all subjects of the program with discussion in room 1 Practical training on ECG. The students will be divided in groups (30 students for group) and with a tutor they will perform ECG recording followed by analysis of results and discussion.
Learning verification modality	The level of learning achieved will be evaluated with an oral final examination consisting of two tests that the student can support at different times. A test is designed to assess the level of knowledge reached on theoretical contents listed in the program related to physiology of the systems (cardiovascular, respiratory, urinary and digestive systems) and the other about contents related to the physiology of the nervous and endocrine systems. In each test, the student will be asked two questions by two different teachers of the course. The test is considered passed if the student achieves sufficiency in both questions. The sequence of tests is chosen by the student. The oral exam will also verify the student communication skills, his ability to organization and exposure of the theoretical topics. The final grade will be the average of the marks obtained in the 4 questions.
Extended program	Cardio-vascular system. Principles of hemodynamics. Physic factors regulating blood flow in the circulatory system. Relationships between pressure, flow and resistance, the Hagen-Poiseuille's Law. Laminar flow and turbulent flow. Factors determining vascular resistance. Hematocrit and blood viscosity. Vascular compliance. Factors determining arterial pressure and pressure difference in the circulatory system. The significance of hydrostatic pressure in the circulatory system and its effects in standing position. The relationship between blood flow and flow velocity in the vascular system. Excitability and automatic rhythmicity of the heart. Mechanisms of self-excitation and conduction of cardiac action potential. Ionic bases of cardiac action potential. Mechanisms of atrio-ventricular conduction delay. Time course of electrical activation of each region of the heart and conduction velocity in different parts of conductive system. Electrocardiogram. Physiological bases of ECG, relationship between electrical phenomena of cardiac excitation, the ECG waves. Characteristics of the normal ECG. The electrocardiographic leads. Diagnostic electrocardiographic interpretation. The mean electrical axes of the ventricles. The cardiac cycle. Cardiac mechanic: the cardiac output Excitation-contraction coupling in the cardiac muscle. Factors determining the contraction strength of cardiac muscle. Isometric and isotonic contraction and the cardiac length-tension relation. The significance of Laplace's law for the hearth. The cardiac cycle: changes in atrial, ventricular and aortic pressures. Functions of the valves. The cardiac work, oxygen consumption and the heart efficiency. Methods for measuring cardiac output. Physiology of cardiac valves, the heart sounds. Mechanisms underlying heart sounds. Auscultation and interpretation of heart sounds. Control mechanisms of cardiac activity Regulation of cardiac output. Control of heart rate and cardiac output. The homeometric and heterometric controls. Assessment of cardiac contractility. Physiology of arterial system. Arterial compliance. Factors determining the mean arterial pressure. The arterial pulse pressure. Transmission of the pressure pulse and changes in the pulse pressure and flow velocity along the arterial system. Methods for measuring arterial pressures. Blood flow measuring methods, the Doppler flowmeters. Physiology of microcirculation and lymphatic system.Functional characteristics of systemic capillaries. Mechanisms of exchange between the blood and interstitial fluid. Role of lymphatic system in controlling interstitial fluid protein concentration, interstitial fluid volume and interstitial fluid pressure. Lymph flow. Conditions causing extracellular edema. Control of blood flow Metabolic, humoral and nervous mechanisms regulating the blood flow in different tissues of the body. Control of arterial pressure Mechanisms involved in short, middle and long-term regulation of arterial pressure. The reflex mechanisms: barocreeptor and chemoreceptor reflexes. The Rennin-Angiotensin system. Il renal-body fluid system. Physiology of venous system Pressure difference in venous return (mean systemic filling pressure and atrial pressure). Phlebogram Combined analysis of cardiac output and venous return curves. Auxiliary factors influencing the venous return and cardiac output and the compensatory mechanisms. Physiology of district circulation Influencing factors and regulating mechanisms of coronary, muscle, skin and brain blood flows Cardio-circulatory readjustments during exercise

HUMAN PHYSIOLOGY - MOD. 4

Code	GP005579
Location	PERUGIA
CFU	3
Teacher	Mauro Pessia
Teachers	Mauro Pessia
Hours	36 ore - Mauro Pessia
Learning activities	Base
Area	Funzioni biologiche integrate di organi, sistemi e apparati umani
Academic discipline	BIO/09
Type of study-unit	Obbligatorio (Required)

HUMAN PHYSIOLOGY - MOD. 5

Code	GP005580
Location	PERUGIA
CFU	3
Teacher	Roberto Panichi
Teachers	Roberto Panichi
Hours	36 ore - Roberto Panichi
Learning activities	Base
Area	Funzioni biologiche integrate di organi, sistemi e apparati umani
Academic discipline	BIO/09
Type of study-unit	Obbligatorio (Required)
Language of instruction	Italian
Contents	Respiratory system: Respiratory mechanic. Pulmonary circulation. Gaseous Exchange. Gas Transport in the blood. Respiration neurogenesis and control. Urinary system: Physiology of nephron: filtration, tubular reabsorption and secretion. Renal mechanisms for controlling water-electrolyte balance. Regulation of Acid-Base balance.
Reference texts	CONTI "Fisiologia Medica", Vol. 2, Ed. Edi-ERMES GAYTON-HALL "Fisiologia Medica", Ed. Edises BERNE-LEVY "Fisiologia" Ed. Ambrosiana WEST " Le Basi fisiologiche della pratica medica", Ed. Piccin
Educational objectives	knowledge of functional and regulatory mechanisms of respiratory and urinary system
Teaching methods	Teaching is organized through: 30 hours of face-to-face lessons on all subjects of the program with discussion in room and 1 Practical training on spirometry. The students will be divided in groups (25-30 students for group) and with a tutor they will perform spirometric examinations followed by analysis of results and discussion.
Learning verification modality	Oral exam
Extended program	RESPIRATORY SYSTEM Respiratory mechanic: Mechanisms of pulmonary ventilation, air movement and the pressures that cause it. Thorax and lung coupling. Pleural pressure. Thorax and lung elastic retraction. Surface tension and surfactant.Laplace's law in the alveoli. Interdependence between alveoli. Changes in lung volume, alveolar pressure, pleural pressure and air flow during normal breathing. The volume-pressure relation in static condition, relaxing curves and compliance. Compliance changes during restrictive pathologies. Airway resistances and the regulating mechanisms. Dynamic airway compression. Dynamic compliance and volume-pressure diagram during breathing, contribution of elastic and viscous resistances. The work of breathing. Changes of work graphical representation during constricted lung diseases and airway obstruction. The pulmonary volumes and capacities and their measurements. Recording changes in pulmonary volume. Spirometry. Methods for measuring the functional residual capacity. Residual volume and total lung capacity. The anatomical and physiologic dead space and their measurement. The minute respiratory volume, pulmonary ventilation, alveolar ventilation and dead space ventilation. The forced expiratory vital capacity and forced expiratory volume in the normal conditions and during diseases (airway obstruction and constricted lungs). Effect of gravity on alveolar ventilation. Pulmonary and bronchial circulations. Pulmonary hemodynamics. Flow, pressure and resistance in the pulmonary circulation system. Passive and active regulation of blood flow in the lungs. Blood flow distribution through the lung and gravity effects. The West's zones. Capillary exchange of fluid in the lungs, role of lymphatics, pulmonary edema. Measurement of anatomical and physiologic shunts. Gaseous exchange: Composition and partial pressures in the atmospheric, inspirated and alveolar air. Diffusion of gases. Diffusion law and factors influencing diffusion rate. Diffusion and perfusion limited gas transfer. Measurement of diffusing capacity. The ventilation-perfusion ratio and its distribution in different parts of the lungs. Gaseous exchange and partial pressure with normal and abnormal ventilation-perfusion rate Compensation of ventilation-perfusion abnormalities. Gas Transport in the blood: Transport of oxygen. The oxygen-hemoglobin dissociation curve, curve analysis and its physiological significance. Factors influencing the oxygen-hemoglobin dissociation curve. The Bohr effect and its physiological significance. Transport of carbon dioxide. The carbon dioxide dissociation curve. The Haldane effect and its physiological significance. Metabolic use of oxygen by the cells. The respiratory exchange ratio. Diffusion of oxygen to the cells and oxygen utilization in different tissues. Effects of ischemia, hypoxia and anemia on the oxygen transport to the tissues.. Respiration neurogenesis: Organization and function of respiratory centers, the respiratory center in the medulla oblungata, apneustic and pneumotaxic centers. The bases of respiration rhythm. Chemical and not chemical controls of respiration. Control of ventilation by central and peripheral chemoreceptors. Respiratory effects of altitude. Role of pulmonary, bronchial and thoracic receptors in regulating respiratory activity and redistributing blood flow and ventilation. Abnormal breathing and breathing during sleep. URINARY SYSTEM Glomerular filtration, tubular reabsorption and secretion. Plasma clearance. Formation of urine: glomerular filtration. Composition of glomerular filtrate, the glomerular membrane. Factors determining glomerular filtration. Glomerular filtration rate (GFR) and inulin clearance, creatinine clearance. Factors determining the renal blood flow, PAH clearance and renal plasmatic flow, filtration fraction. Regulation of glomerular filtration rate and renal blood flow. Autoregulation of the GFR and renal blood flow. Tubuloglomerular feedback. Formation of urine: tubular reabsorption, secretion and escretion. Clearance and measurement of tubular reabsorption and secretion, tubular load, escreted load and reabsorbed or secreted load. Active and passive absorption, Maximum tubular transport. Reabsorption and secretion in different segment of nephron. Tubular reabsorption regulation. Processing of the main plasma constituents in the kidney. Glucose: Glucosereabsorption, threshold for glucose, loss of glucose in the urine. Balance of Urea, Sodium, Potassium, Calcium, Phosphate and Magnesium. Renal mechanisms for controlling water-electrolyte balance: Body fluids and renal function, intake versus output of water. Measurement of body fluid volumes. Effect of adding iso-hyper and hypotonic solutions. Transport of water and solutes in different nephron segments. The mechanisms for excreting a concentrated or dilute urine. The countercurrent mechanism. Osmolar clearance and free water clearance. Role of ADH. Osmotic and hemodynamic control of ADH release. Thirst mechanism. Control of extracellular fluid volume and regulation of NaCl excretion. Renin-Angiotensin system, Aldosterone, Atrial natriuretic peptide. Control of sodium excretion with normal ECV, during volume increase or decrease. The micturition reflex. Control of micturition by the brain Regulation of Acid-Base balance: Defense against pH changes, the acid-base buffers. The Henderson-Hasselbalch Equation. Titration curve for the bicarbonate buffer system. Respiratory regulation of acid-base balance. Renal control of acid-base balance. Kidney capability to excrete acidic urine: bicarbonato reabsorption, titolable acidity, Excretion of ammonium ion. Respiratory and metabolic acidosis and alkalosis and compensation mechanisms.