OVERVIEW

The teaching of Human Physiology I provides the elements to understand the functioning of the apparatuses that oversee vegetative life and their dynamic integration in the maintenance of homeostasis of the organism in healthy humans and to know the principles of application of biophysics and biomedical technologies to medicine.

AIMS AND CONTENT

LEARNING OUTCOMES

The students will reach a full knowledge of the general physiology and functioning of the cardiovascular, respiratory, renal, and digestive systems and the basics of nutritional science and sports physiology and their dynamic integration in maintaining the body's homeostasis

AIMS AND LEARNING OUTCOMES

The purpose of this course is to provide students  with the knowledge of the apparatuses cardiovascular, respiratory, renal, digestive and the basics of nutritional science and sports physiology that oversee vegetative life and their dynamic integration in maintaining the body's homeostasis.

PREREQUISITES

Physiology is the scientific study of the functioning of the living organism, in terms of physical and chemical processes. Students will achieve better results in the understanding physiology if they can rely on solid foundations in mathematics, physics, chemistry, biochemistry and biology. 

TEACHING METHODS

Frontal Lessons

Laboratories of cardicirculatory and respiratory physiology

Any Student with documented Specific Learning Disorders (SLD), or with any special needs, shall reach out to the Lecturer(s) and to the dedicated SLD Representative in the Department before class begins, in order to liase and arrange the specific teaching methods and ensure proper achievement of the learning aims and outcomes.

SYLLABUS/CONTENT

CELLULAR PHYSIOLOGY

The membrane potential. Composition of intra- and extracellular fluid compartments. Structure and characteristics of the plasma membrane. Movement of ions across the membrane: ion channels and transporters. The principle of electrical neutrality. Measurement of resting membrane potential. Origin of resting membrane potential. Chemical gradient and electrical gradient. Nernst equation and equilibrium potential for various ionic species. Goldman's equation. Depolarization and hyperpolarization. The Na+/K+- ATPase pump. The passive properties of the membrane. Membrane response to current. The equivalent circuit: conductance and capacitance. Time and  Space constants.

The active properties of the membrane: the action potential. Non-excitable cells and excitable cells. Voltage-dependent channels: structural and functional aspects. The different phases of the action potential and associated ion fluxes. Concepts of threshold, all-or-none event and refractoriness. Application of voltage-clamp and patch-clamp techniques. Propagation of action potential. Non-decremental propagation. Point-to-point conduction and saltatory conduction. Directionality of action potential conduction. Role of passive membrane and myelin sheath properties in action potential conduction.

Skeletal muscle. Outline of anatomical, histological, cytological and molecular organization. Actin/myosin, sarcomere, sliding theory, transverse bridge cycle. Control: motor nerves and motor units, neuromuscular plaque, excitation/contraction coupling. Types of skeletal musculature.  Muscle Strength Modulation: recruitment, simple shock and complete incomplete tetanus. Isometric and isotonic contraction. T/L and F/Vel reports.

Smooth muscle. Ultrastructure of smooth muscle. Contraction and excitation-contraction coupling in smooth muscle. Intercellular junctions in smooth muscle. Mechanical characteristics and contraction mode of smooth muscle. Smooth muscle innervation and pacemaker potentials. Fast and slow cycle.

CARDIOVASCULAR PHYSIOLOGY

General aspects and components of the cardiovascular system. Unicellular and multicellular organisms. Diffusion of gases and nutrients. Need for a distribution system. Functions and characteristics of the cardiovascular system. Blood and hemostasis. Blood composition: plasma, serum, figured elements, hematopoiesis and generalities on erythrocytes, leukocytes, thrombocytes; blood volume and regulatory factors. Hemostasis: vasomotor response; platelet adhesion and aggregation. Coagulation: intrinsic and extrinsic mechanisms. Fibrinolysis and clot retraction.

Principles of hemodynamics. Bernoulli's law and principle of flow-continuity. Hagen- Poiseuille's law. Flow resistance: vessel factors. Series and parallel vessels. Resistance to flow: blood viscosity. Laminar flow and turbulent flow. Axial accumulation of red blood cells. Critical velocity. Influence of gravity on circulation. Diagnostic role of turbulent motion.

Electrical activity of the heart. Electrical properties of the myocardium: automaticity, conductivity, excitability. The myocardial action potential and its ionic basis. The automatism of the heart: primary and secondary starters. Ionic bases of automatism and its modulation by the vegetative nervous system. The conduction system and propagation of the action potential in the myocardium. Abnormal conduction bundles. Correlation between electrical and mechanical events.

The electrocardiogram (EEG). Fundamentals of electrocardiography. The cardiac electric vector. Bipolar and unipolar leads. The electrocardiographic tracing: nomenclature. Origin of electrocardiographic waves. The EEG: interpretation of the traces originating from various leads. Electrical axis of the heart. The pathological electrocardiogram (rhythm or conduction disturbances, ischemic heart disease).

Mechanical properties of myocardial fibers. Contractile proteins and molecular mechanism of contraction. Excitation-contraction coupling: receptors for ryanodine, calcium release from intracellular stores. Elastic component and contractile component. Isometric contraction and isotonic contraction. Force-length curve and force-velocity curve. Definition of preload and afterload. The heart as a pump. Anatomic-functional aspects of the cardiac pump: muscle bundles, atrioventricular and semilunar valves. Mechanical events of the cardiac cycle: pressor, volumetric and valvular aspects. Origin and characteristics of cardiac tones. Heart murmurs and valvular defects. Correlation between electrical, mechanical and phonic events. Bioenergetics and myocardial metabolism. Work and performance of the heart. Laplace's law applied to the heart. Homeometric and heterometric intrinsic regulation of contractility. Starling's law. Extrinsic regulation of heart rate and contractility. Ventricular or Sarnoff performance curves. Cardiac failure.

General characteristics of blood vessels. Functional organization of the vessel system. Properties of vessel walls. Elastic and muscular vessels. Transmural pressure. Distensibility and critical closing pressure. Resistance vessels and capacitance vessels. Pressure-volume relationship in the circulatory system. Laplace's law.

Arterial pressure and pulse wave. Systolic, diastolic and differential pressure. Elasticity of the great and middle arteries. The pulse wave or sphygmic wave: genesis, phases and propagation. The normal and pathological pulse. Direct and indirect measurement of blood pressure.

The microcirculation. Cytoarchitectonics of microcirculation. Continuous, fenestrated and discontinuous capillaries. Mechanisms of exchange at the capillary level. Diffusion. Filtration: Starling's hypothesis. Lymphatic circulation. Pathophysiology of capillary exchange: edema.

Venous return to the heart. Hemodynamic factors. Venous valves and muscle pump. Auxiliary factors. Relationship between venous return and cardiac output.

Control of the circulation. Regional and supraregional control of the circulation. Vasomotility. Local autoregulation. Vasodilator metabolites. The control of systemic blood pressure. The baroreceptor reflex (receptors, afferent pathways, bulbar centers, efferent pathways). Hormonal control. Renal control (pressure diuresis).

Circulation in special districts. Coronary circulation: hemodynamic events and humoral regulation. Cerebral, pulmonary, splanchnic and cutaneous circulation.

RESPIRATORY PHYSIOLOGY

Mechanics of respiration. Respiratory muscles and their mechanical effects. Definitions of lung volumes and capacities. Benedict's spirometer. Statics. Relaxation curve of the lung-thorax system. Compliance and its variations. Elastance. Pressure/volume diagram of the isolated lung. Pressure/volume diagram of the thorax. Dynamics. Pressure/flow diagram. Pressure/volume diagram. Respiratory function tests. Respiratory work. Ventilation/perfusion relationship. Pulmonary perfusion: pressure regime in the small circle; vascular resistances and their variations in relation to lung pressure and volume; pulmonary blood flow; regional distribution of perfusion; effects of posture on perfusion. Pulmonary ventilation and its regional differences. Ventilation/perfusion ratio and its regional differences. Alterations in respiratory mechanics under pathological conditions.

Respiratory gases and alveolus-capillary exchanges. Atmospheric air. Composition and variations in relation to altitude. Alveolar air. Composition and variations in relation to respiratory cycle phase and lung region. Alveolus-capillary exchanges: constituent structures of the exchange surface; basic principles of diffusion; equilibrium of gases in pulmonary capillaries; measurement of diffusion capacity in the lung. O2 transport. O2 content in arterial and venous blood: physical solution, hemoglobin, Hb types and their dissociation curves, Hb/O2 affinity changes; Bohr effect; Hb as a buffer. O2 exchanges in lungs and tissues. CO2 transport. CO2 content in arterial and venous blood: physical solution, carbamino compounds, carbonic acid/bicarbonates; pCO2/[CO2] diagram: Haldane effect. CO2 exchanges in lungs and tissues.

Nervous control of respiration. Central nervous mechanisms: bulbar, pontine, forebrain. Genesis of respiratory rhythm. Peripheral nerve mechanisms: proprioceptive (insufflation reflexes, deflation reflexes, stretch reflexes); exteroceptive; baroceptive; J receptors. The chemical control of respiration. Central mechanisms: physiology of bulbar chemosensitive areas. Peripheral mechanisms: physiology of aortic and carotid glomas. Acute and chronic ventilatory responses to changes in pCO2, pO2, [H+].

RENAL PHYSIOLOGY

Water compartments of the organism. Identification of the major water compartments and their physicochemical characteristics. Processes involved in solute and solvent transfer between compartments: diffusion, hydrostatic pressure, osmotic pressure. Osmolarity and tonicity. Determination of volume of water compartments using indicator substances. Oncotic pressure. Gibbs-Donnan equilibrium.

Aspects of functional anatomy of the kidney. Hints of renal anatomy: parenchyma, vessel bed, innervation. The functional unit of the kidney: the nephron, vascular part and tubular part. Cortical and juxtamidullary nephrons. Functions of the renal apparatus. Osmotic balance. Balance of various chemical species. Acid-base balance. Control of nitrogenous waste concentration. Detoxification. Control of blood pressure. Endocrine functions: erythropoietin and vitamin D activation.

Renal ultrafiltration. Filtration and ultrafiltration. Ultrafiltrate/ultrafiltrate ratio. Composition of ultrafiltrate. Pressure of ultrafiltration. Characteristics of the filter membrane: ultrastructure of the glomerulus and selective permeability of the filtration barrier. Effect of molecular weight, shape and electrical charge of plasma substances on ultrafiltrate/ultrafiltrate ratio. Glomerular filtration rate and its intrinsic and extrinsic regulation.

Renal plasma flow. Autoregulation of renal plasma flow and glomerular filtration rate. Bayliss reflex, renin-angiotensin system and prostaglandins. Extrinsic nervous control.

Tubular reabsorption and secretion processes. Active and passive mechanisms of tubular transport. Primary and secondary active transport.. Example of tubular reabsorption: glucose, theoretical and empirical renal threshold. Example of tubular secretion: p-amino-hypuric acid (PAI). Renal clearance. Definition of clearance. Determination of glomerular filtration rate by inulin and creatinine clearance. Clearance values for reabsorbed and secreted substances. Determination of renal plasma and blood flow by PAI clearance. Filtration fraction.

The reabsorption of sodium and water. Central role of sodium transport in renal function. Regulation of excreted sodium load. Sodium and water reabsorption in the proximal segments of the nephron. Osmotic diuresis. Genesis and maintenance of the cortico-medullary osmotic gradient: mechanism of concentration multiplication by countercurrent and function of vasa recta. Water reabsorption in the distal segments of the nephron. Mechanism of action of ADH. Regulation of other solutes balance. Regulation of potassium balance. Regulation of calcium, phosphorus, magnesium, phosphate and amino acid balance. Tubular urea reabsorption and urea clearance.

Regulation of osmolarity and body fluid volume. Osmotic and volume work in the state of diuresis and antidiuresis. Osmolar clearance and free water clearance. Osmoreceptors, volumoreceptors and regulation of ADH secretion. Renal compensations.

Regulation of acid-base balance. The pH of body fluids. Main buffer systems of the body. The Henderson-Hasselbalch equation. The carbonic acid-bicarbonate system. The kidney in maintaining circulating buffer systems: excretion of titratable acidity and ammonium ions, reabsorption of bicarbonates. Metabolic and respiratory acidosis and alkalosis. Davenport's diagram. Respiratory and renal compensation. Physiology of the action of diuretics. Site and mechanism of action of the major classes of diuretics: osmotic diuretics, carbonic anhydrase inhibitors, loop diuretics, thiazide diuretics, potassium-sparing diuretics.

PHYSIOLOGY OF DIGESTION AND NUTRITION.

Physiology of nutrition. Foods. Energy metabolism. Determination of energy requirements, energy value of foods, measurement of energy expenditure, direct and indirect calorimetry. Basal metabolism, measurements and changes in basal metabolism. Total energy requirements, calculation of caloric requirements. Dietary ration, requirements of: protein, lipids and glycides, dietary fiber, beverages, fat-soluble vitamins: A, D, E, K, F, water-soluble vitamins: B1, B2, B3, B5, B6 B8 B9 B12,C, major minerals: calcium, phosphorus, magnesium sodium chloride and potassium and sulfur, trace minerals: iron, zinc, iodine, fluoride. Water.

Mechanisms of hunger and satiety: central and peripheral mechanisms: long-term and short-term.

Enteric nervous system. Innervation of the gastrointestinal tract, sympathetic, parasympathetic and enteric divisions. Enteric nervous system organization, ganglionic and aganglionic plexuses. Enteric neurons, morphological and functional classification and their distribution. Mechanisms of neuronal transmission. Receptors for neurotransmitters and neuromodulators. Functional relationships among enteric neurons: junction between enteric neurons and effector cells, inhibitory and excitatory motor neurons. Electrical and synaptic behavior of enteric neurons: fast, slow PPE and slow PPI, gate mechanisms. Extrinsic gastrointestinal tract innervation, sympathetic and parasympathetic reflexes.

Gastrointestinal motility. Muscle activity: nerve modulation, contraction and relaxation, electrical waves frequencies and molecular mechanisms, extrinsic innervation, motor functions and types of motility, physiological ileus, sphincters. Chewing and swallowing. Esophageal motility. Gastric motility: gastric reservoir,nerve modulation and release. Antral pump, action potential and loop contraction. Gastric emptying. Small intestine motility, functional organization, types of motility, interdigestive motility and migrating motor complex, digestive motility, propulsion and mass movements. Large intestine motility, functional organization, cecum, colon rectum sigmoid region and anal canal. Defecation.

Gastrointestinal secretions. Salivary secretion, morphofunctional organization, composition and function of saliva, regulation of salivary secretion. Gastric secretion, morphofunctional organization, cell types, acid secretion, mucosal barrier, electrolytes gastric juice, regulation acid secretion, pepsin, lipase, mucus, intrinsic factor. Pancreatic secretion, morphofunctional organization, aqueous and protein secretion, regulation of pancreatic secretion,meal response. Biliary secretion, morphofunctional organization, bile composition and production, bile transport and storage bile release in the duodenum. Intestinal secretion, small and large intestine secretion.

Digestion and absorption. Morphofunctional organization, gut, mechanisms of digestion and absorption, digestion and absorption of carbohydrates, proteins, lipids vitamins. Electrolyte absorption, water, minerals and trace minerals.

SPORTS PHYSIOLOGY.

Definitions. neuro-motor exercise; muscle work; neuro-motor exercise training and physiological work. Bioenergetics. physical and physiological equivalents of work: metabolism in the course of work and training. Morphological and metabolic adaptations in the course of exercise. Training. typology of striated muscles, typology of training methods (sports and athletic). Effects of work and training on digestive, cardiovascular, respiratory, neuroendocrine, thermoregulatory; excretory systems.

Nutrition and Sport. Energy nutrient requirements in sports activity; "plastic" and "regulatory" nutrients for the sportsman. Assessment of the nutritional status of the sportsman. Dietary rations and type of training. Dietary regimen in relation to the type of sports performance. Dietary methodologies for recovery of reserves in pre- and post-competitive phases.

RECOMMENDED READING/BIBLIOGRAPHY

Berne, Levy et al. FISIOLOGIA CEA

Conti et al. FISIOLOGIA MEDICA (2° ed.) Edi-Ermes

Guyton et al. Fisiologia Medica EDRA

Berne & Levy, FISIOLOGIA CARDIOVASCOLARE ,McGraw-Hill

Vander, FISIOLOGIA RENALE, McGraw-Hill

Koeppen & Stanton, FISIOLOGIA RENALE, Masson

West, FISIOLOGIA DELLA RESPIRAZIONE, Piccin

TEACHERS AND EXAM BOARD

Exam Board

PIETRO BALDELLI (President)

FABIO BENFENATI (President)

EMANUELA LUISA FAELLI (President)

SILVIA GIOVEDI' (President)

FRANCO ONOFRI (President)

PIERO RUGGERI (President)

PIERLUIGI VALENTE (President)

LESSONS

LESSONS START

First semester (end of Semptember, early October)

Class schedule

The timetable for this course is available here: Portale EasyAcademy

EXAMS

EXAM DESCRIPTION

Written + Oral Examination

To access the oral examination, a written test, consisting of 30 multiple choice questions must be passed. A minimum score of 15 points must be achieved (the score is distributed as follows: points 1 for each right question; points: -0.25 for each wrong question; no points to unanswered questions).  In case of failing the oral test, the written test must be repeated.

ASSESSMENT METHODS

In the oral examination, the candidate's preparation is assessed by three different  Physiology lecturers. The candidate must demonstrate knowledge of general physiology and physiology of the apparatuses.

FURTHER INFORMATION

Slides of lectures presented by the lecturers are available on AulaWeb.