MDSC 1001 PBL PROBLEM 2

By Arvind Seecharan
(Future Doctor Extraordinaire)
Learnlng ob[ecLlve 1
W uescrlbe how body waLer ls dlsLrlbuLed and
lLs varlous comparLmenLs
@oLal 8ody WaLer (@8W)
W @he mosL abundanL componenL of Lhe human
body
W ulsLrlbuLed beLween Lwo maln componenLs
Lhe lnLracellular fluld (lCl)
Lhe exLra cellular fluld (LCl)
W @he lCl makes up 2/3 of Lhe @8W and exlsLs
lnslde cells
W @he LCl makes up 1/3 of Lhe @8W and exlsLs
ouLslde cells
W @he LCl can be furLher subdlvlded lnLo Lwo
porLlons
lasma (approxlmaLely 20 of Lhe LCl)
lnLersLlLlal fluld (approxlmaLely 80 of Lhe LCl)
W lasma exlsLs lnslde Lhe blood vessels and ls
Lhe llquld porLlon of Lhe blood
W lnLersLlLlal lluld exlsLs ouLslde blood vessels
and occuples Lhe mlcroscoplc spaces beLween
Llssue cells
%otal Body Water
(%BW)
Extracellular
Fluid (1/3 %BW)
Interstitial Fluid
(4/5 ECF, between
tissue cells)
Plasma
(1/5 ECF, inside
blood vessels)
Intracellular
Fluid (2/3 %BW)
Learnlng Cb[ecLlve 2
W ulscuss Lhe use of uarrow ?aneLL ulagrams
WhaL ls a uarrow?aneLL ulagram
W A uarrow ?anneL dlagram ls a schemaLlc used
ln physlology Lo glve a slmple assessmenL of
volume and osmolallLy sLaLus of body
Learnlng Cb[ecLlve 3
W uescrlbe Lhe LplLhellal Llnlng and lLs role
8aslc SLrucLure of an LplLhellal Cell
LplLhellal @lssue
W Covers body surfaces and llnes hollow organs
body cavlLles and ducLs lL also forms glands
W ConslsLs of cells arranged ln conLlnuous sheeLs
(slngle or mulLlple layers)
W uensely packed held LogeLher by numerous
cell [uncLlons
W Are avascular
W Iery llLLle exLracellular space exlsLs beLween
ad[acenL plasma membranes
W @he Aplcal surface may be exposed Lo
A body cavlLy
@he lumen of an lnLernal organ
@he exLerlor or Lhe body
W @he basal surface adheres Lo an ad[acenL
connecLlve Llssue wlLh Lhe basemenL
membrane
W @he basemenL membrane conslsLs of Lwo layers
@he basal lamlna
@he reLlcular lamlna
W @he basal lamlna ls comprlsed of collagen
flbres and proLelns
W @he reLlcular lamlna ls made up by reLlcular
flbres and flbronecLln
Slmple Squamous LplLhellum
W ConslsLs of a slngle very Lhln layer flaLLened
(squamous) cells
W LocaLed aL
SlLes of rapld dlffuslon
W @he llnlng of lung alveoll
W @he llnlng of blood vessels (called endoLhellum)
AL slLes where very llLLle acLlvlLy ls occurrlng
W Such as 8owmans capsule ln Lhe kldney
W @he llnlng of ma[or body cavlLles (called mesoLhellum)
Slmple Columnar eplLhellum
W ConslsLs of a slngle layer of Lall (columnar
cells)
W usually lnvolved ln acLlve secreLlon and/or
absorpLlon of maLerlal across Lhe slngle cell
layer or (lf clllaLed) ln movemenL along Lhe
surface
W Slmple columnar eplLhellum llnes Lhe
dlgesLlve LracL and Lhe female reproducLlve
LracL (as well as numerous oLher surfaces)
Slmple Columnar LplLhellum
W Cccur ln one or more layers
W @he cells are elongaLed and columnshaped
W @he nuclel are elongaLed and are usually
locaLed near Lhe base of Lhe cells
Slmple Columnar LplLhellum
W lorms Lhe llnlng of Lhe sLomach and lnLesLlnes
W Some columnar cells are speclallsed for sensory
recepLlon such as ln Lhe nose ears and Lhe LasLe
buds of Lhe Longue
W CobleL cells (unlcellular glands) are found
beLween Lhe columnar eplLhellal cells of Lhe
duodenum @hey secreLe mucus or sllme a
lubrlcaLlng subsLance whlch keeps Lhe surface
smooLh
Slmple Cuboldal LplLhellum
W 8oughly square or cuboldal ln shape
W Lach cell has a spherlcal nucleus ln Lhe cenLre
W Cuboldal eplLhellum ls found ln
glands
Lhe llnlng of Lhe kldney Lubules
@he germlnal eplLhellum whlch produces
W Lhe egg cells ln Lhe female ovary
W Lhe sperm cells ln Lhe male LesLes
SLraLlfled Squamous eplLhellum
W ConslsLs of flaLLened (squamous) cells on Lhe
surface overlylng mulLlple layers of cells LhaL
usually are more cuboldal Loward Lhe base of Lhe
eplLhellum
W SLraLlfled squamous eplLhellum ls usually
n @he mulLlple layers are Loo Lhlck for
efflclenL LransporL of maLerlals (nelLher secreLory
or absorpLlve)
W @he lnnermosL layer conLlnually produces cells
(vla mlLosls) Lo replace Lhose losL from Lhe ouLer
surface
W CuLer layers may be keraLlnlzed (dead and
hardened) on dry surfaces such as
skln keraLlnlzaLlon provldes exLra proLecLlon
agalnsL abraslon and desslcaLlon
W AlLernaLlvely ouLer layers may be
nonkeraLlnlzed on weL mucous surfaces such
as Lhe cornea of Lhe eye or Lhe llnlng of Lhe
upper Cl LracL (eg cheek and esophagus)
Clandular eplLhellum
W Seclallzed for secreLlon Clandular eplLhellum forms more
orless complex lnvaglnaLlons of eplLhellal Llssue LhaL lle
deep Lo Lhe surface eplLhellum llnlng obvlous exLernal and
lnLernal body surfaces
W Clandular eplLhellum may be dlfferenLlaLed lnLo secretory
un|ts (whlch can be speclallzed for varlous producLs) and
ducts (whlch Lyplcally appear less speclallzed alLhough
ducLs may funcLlon acLlvely Lo reabsorb waLer and Lhus
concenLraLe Lhe secreLory producL)
W AlLhough large exocrlne glands llke Lhe llver and pancreas
may appear solld each secreLory cell has an aplcal surface
exposed Lo a lumen @hls lumenal space ln Lurn leads
Lhrough ducLs Lo Lhe ouLslde of Lhe body
luncLlons
W roLecLlon
LplLhellal cells from Lhe skln proLecL underlylng Llssue
from mechanlcal ln[ury harmful chemlcals lnvadlng
bacLerla and from excesslve loss of waLer
W SensaLlon
Sensory sLlmull peneLraLe speclallsed eplLhellal cells
Speclallsed eplLhellal Llssue conLalnlng sensory nerve
endlngs ls found ln Lhe skln eyes ears nose and on
Lhe Longue
W SecreLlon
ln glands eplLhellal Llssue ls speclallsed Lo secreLe
speclflc chemlcal subsLances such as enzymes
hormones and lubrlcaLlng flulds
W AbsorpLlon
CerLaln eplLhellal cells llnlng Lhe small lnLesLlne
absorb nuLrlenLs from Lhe dlgesLlon of food
W LxcreLlon
LplLhellal Llssues ln Lhe kldney excreLe wasLe producLs
from Lhe body and reabsorb needed maLerlals from
Lhe urlne SweaL ls also excreLed from Lhe body by
eplLhellal cells ln Lhe sweaL glands
W ulffuslon
Slmple eplLhellum promoLes Lhe dlffuslon of gases
llqulds and nuLrlenLs 8ecause Lhey form such a Lhln
llnlng Lhey are ldeal for Lhe dlffuslon of gases (eg
walls of caplllarles and lungs)
W Cleanlng
ClllaLed eplLhellum asslsLs ln removlng dusL
parLlcles and forelgn bodles whlch have enLered
Lhe alr passages
W 8educes lrlcLlon
@he smooLh LlghLlylnLerlocklng eplLhellal cells
LhaL llne Lhe enLlre clrculaLory sysLem reduce
frlcLlon beLween Lhe blood and Lhe walls of Lhe
blood vessels
Learnlng Cb[ecLlve 4
W LlsL Lhe dlfferenL Lypes physlologlcal causes
and effecLs of dehydraLlon
@ypes of dehydraLlon
W lsoosmoLlc dehydraLlon
W PyperosmoLlc dehydraLlon
W PypoosmoLlc dehydraLlon
lsoosmoLlc dehydraLlon
W Cccurs when fluld ls losL from Lhe plasma and
Lhen ls depleLed from Lhe lnLersLlLlal space
W no ma[or change occurs ln Lhe osmolallLy of
LCl Lherefore Lhere are no fluld shlfLs lnLo or
ouL Lhe lCl comparLmenL
Causes of lsoosmoLlc dehydraLlon
W Pemorrhage
W lasma loss
W LxudaLlon Lhrough burned skln
W CasLrolnLesLlnal fluld loss (eg vomlLlng
dlarrhea)
PyperosmoLlc dehydraLlon
W lnlLlally fluld ls losL from Lhe plasma whlch
becomes hyperosmoLlc
W Causlng a fluld shlfL from Lhe lnLersLlLlal fluld
Lo Lhe plasma
W @he rlse ln lnLersLlLlal fluld osmolallLy causes
fluld shlfL from Lhe lCl Lo Lhe LCl llnally boLh
Lhe LCl and lCl comparLmenLs are decreased
and Lhe osmolallLy ls lncreased
Causes of PyperosmoLlc dehydraLlon
W WaLer deflclLs caused by decreased lnLake
W ulabeLes lnslpldus
W ulabeLes melllLus
W lever (Lhrough excesslve evaporaLlon of Lhe
sweaL from Lhe skln sweaL ls hypoLonlc)
PypoCsmoLlc uehydraLlon
W Causes of hyposmoLlc dehydraLlon lnclude
renal loss of naCl because of adrenal
lnsufflclency (eg prlmary
hypoadrenocorLlcallsm Addlson's dlsease)
Learning Objective 5
W LlsL Lhe dlfferenL Lypes physlologlcal causes
and effecLs of dlahorrea
@ypes of ularrhea
W LnLerlLls
W sychogenlc ularrhea
W ulceraLlve CollLls
LnLerlLls
W Caused by elLher a vlrus or bacLerlal lnfecLlon
ln Lhe lnLesLlnal LracL
W @he lnfecLlon ls usually mosL exLenslve
LhroughouL Lhe enLlre large lnLesLlne and Lhe
dlsLal end of Lhe lleum
W Wherever Lhe lnfecLlon ls presenL Lhe mucosa
becomes severely lrrlLaLed Lhereby greaLly
lncreaslng lLs raLe of secreLlon
W @he moLlllLy of Lhe lnLesLlnal wall also exhlblLs
a vasL lncrease
W @hese reacLlons resulL ln maklng large
quanLlLles of fluld avallable for washlng Lhe
lnfecLlous agenL Lowards Lhe anus whlle
concurrenLly Lhe sLrong propulslve
movemenLs of Lhe lnLesLlnal walls drlve Lhe
fluld forwards
W ln Lhls way Lhe lnLesLlnal LracL rlds lLself of Lhe
lnfecLlon
sychogenlc ularrhea
W Caused by excesslve sLlmulaLlon of Lhe
parasympaLheLlc nervous sysLem(also called
psychogenlc emoLlonal dlarrhea)
W @he sLlmulaLlon greaLly exclLes Lhe moLlllLy
and mucus secreLlon of Lhe dlsLal colon
W @hese Lwo effecLs comblned resulLs ln lnLense
dlarrhea
ulceraLlve CollLls
W A chronlc dlsease resulLlng ln boLh Lhe
ulceraLlon and lnflammaLlon of pervaslve
secLlons of Lhe walls belonglng Lo Lhe large
lnLesLlnes
W @he moLlllLy of Lhe ulceraLed walls ls so
exponenLlally lncreased LhaL raLher Lhan
movlng 1030 mlnuLes per day as ls Lhe norm
Lhey are almosL ln a sLaLe of perpeLual moLlon
W ln addlLlon Lo Lhls Lhe secreLlons of Lhe colon
exhlblL a marked lncrease
W @hese sympLoms culmlnaLe Lo produce
repeaLed dlarrheal bowel movemenLs
Learning Objective 6
W 5ain the mechanism oI action oI the choera
toin.
What is Cholera?
W hoera as deIined by the Mayo inic as a
bacteria disease usuay s5read through
contaminated water. hoera causes severe
diarrhea and dehydration. LeIt untreated,
choera can be Iata in a matter oI hours even
in 5reviousy heathy 5eo5e.
What Causes Cholera?
W Cholera ls caused by a bacLerlum called Ilbrlo
cholerae
W ln Lhe small lnLesLlne Lhe bacLerla produces a
Loxln called C@O whlch resulLs ln Lhe dlsease's
deadly effecLs
W % works by binding to the immature
e5itheia ces on was oI the intestina cry5ts,
where it triggers the Iormation oI arge
amounts oI cycic adenosine mono5hos5hate.
W %he ecessive quantities oI cycic adenosine
mono5hos5hate then cause the o5ening oI
arge numbers oI chorine channes in the ce
membranes, which then resuts in the ra5id
Iow oI Cl
-
ouL of Lhe cells lnLo Lhe lnLesLlnal
crypL
W @he efflux of Cl
-
lnLo Lhe crypLs acLlvaLes
sodlum pumps ln Lhe cells whlch pump na
+
lnLo Lhe crypLs as well
W @hls accumulaLlon of na
+
and Cl
-
glves rlse Lo
very hlgh concenLraLlons of naCl
W @he culmlnaLlon of Lhese evenLs aggregaLes
lnLo exLreme osmosls of waLer lnLo Lhe crypLs
W normally Lhe maLure eplLhellal cells hlgher up
on Lhe vllll lmmedlaLely reabsorb Lhe small
amounL of naCl + WaLer secreLlons from Lhe
crypL (lL provldes a soluLlon for Lhe absorpLlon
of lnLesLlnal dlgesLaLes)
W Powever Lhe sheer volume of soluLlon now
belng secreLed effecLlvely lnundaLes Lhe
reabsorbLlon effecL
W @hls resulLs ln 310 L of waLer belng losL dally
W WlLhln 13 days many severely affecLed
paLlenLs dle due Lo Lhe dehydraLlon caused by
Lhe loss of Lhls fluld alone
Learnlng Cb[ecLlve 7
W ueLermlne how bolllng waLer ensures LhaL lL ls
safe Lo drlnk
ueconLamlnaLlon
W ueconLamlnaLlon ls Lhe process of removal of
conLamlnaLlng paLhogenlc mlcroorganlsms
from Lhe arLlcles by a process of sLerlllzaLlon
or dlslnfecLlon lL ls Lhe use of physlcal or
chemlcal means Lo remove lnacLlvaLe or
desLroy llvlng organlsms on a surface so LhaL
Lhe organlsms are no longer lnfecLlous
,olsL PeaL
W ,olsL heaL acLs by coagulaLlon and
denaLuraLlon of proLelns
W AL LemperaLure 100C
8olllng 8olllng waLer (100C) kllls mosL vegeLaLlve
bacLerla and vlruses lmmedlaLely CerLaln bacLerlal
Loxlns and some bacLerlal spores reslsLanL Lo heaL
and bolllng hence Lhls ls noL a subsLlLuLe for
sLerlllzaLlon
Learnlng Cb[ecLlve 8
W uescrlbe Lhe LnvlronmenLal lacLors LhaL
lmpacL on Lhe healLh and wellness of
communlLles lncludlng waLer supply
W LnvlronmenLal facLors affecL human healLh ln
lmporLanL ways boLh poslLlve and negaLlve
oslLlve LnvlronmenLal lacLors
W oslLlve envlronmenLal facLors susLaln healLh and
promoLlng Lhem ls prevenLlve medlclne @hey
lnclude
sources of nuLrlLlon (farmlng soll quallLy waLer
avallablllLy blodlverslLy/blolnLegrlLy geneLlcally
modlfled organlsms (C,Cs) hunLlng flshlng wlldllfe
flsh populaLlons)
waLer (drlnklng cooklng cleanlng / sanlLaLlon)
alr quallLy
ozone layer (proLecLlon from uI cancers eLc)
space for exerclse and recreaLlon
sanlLaLlon / wasLe recycllng and dlsposal
negaLlve LnvlronmenLal lacLors
W -egat|ve envlronmenLal facLors are LhreaLs Lo
healLh and conLrolllng Lhem ls publlc
envlronmenLal healLh @hey lnclude
envlronmenLal condlLlons favourlng dlsease
vecLors
lnvaslve bloLa (vlruses bacLerla eLc) Lhelr hosLs
and vecLors
envlronmenLal dlsrupLlons floods droughLs
sLorms flres earLhquakes volcanoes
envlronmenLal dlsrupLlons floods droughLs sLorms
flres earLhquakes volcanoes
alr quallLy pollen and polluLlon leadlng Lo resplraLory
dlseases or cancers
waLer quallLy bloLlc and abloLlc conLamlnanLs
lnLegrlLy of waLer LransporL and LreaLmenL
lnfrasLrucLure
monlLorlng and managemenL of munlclpal
agrlculLural lndusLrlal ouLflows Lo Lhe envlronmenL
(gases llqulds solld wasLes)
human changes of Lhe envlronmenL LhaL
W CreaLe condlLlons LhaL favour dlsease
W dlsLurb and release noxlous levels of prevlously
bound chemlcals (eg mercury released
becomes polson) or bloLa (eg meLhane
released from Lhawed peaL conLrlbuLes Lo
cllmaLe change)
W creaLe Lemporary lnLense llfeLhreaLenlng heaL
lslands (eg urban heaL waves exacerbaLed by
cllmaLe change)
W resulL from nuclear blologlcal or chemlcal
warfare or Lerrorlsm
W dlsrupLlon caused by oLher war and vlolence
Learnlng Cb[ecLlve 9
W ulscuss Lhe use of Lpldemlology Lo lnvesLlgaLe
ubllc PealLh problems
WhaL ls Lpldemlology
W lL ls Lhe sLudy of Lhe occurrence of lllness
W lL ls a sLudy of populaLlons
W lLs aeLlologlcal ln naLure
W lL ls Lhe sLudy of deLermlnanLs of dlsease
W lL asks Lhe quesLlons who where when how
how many why
uses of Lpldemlology
W LsLlmaLlng Lhe lncldence of and rlsk facLors
for rarely occurrlng evenLs ln large
populaLlons exposed Lo a medlclne
W SLudylng evenLs wlLh a long laLency perlod
8eferences
W hLLp//wwwncblnlmnlhgov/pubmedhealLh/
W hLLp//wwwmayocllnlccom/healLh/cholera/
W hLLp//wwwpharmacyescrowcom/blog/wp
conLenL/uploads/2010/09/CholeraouLbreaklnAfrlca1[pg
W CuyLon AC (1987) Puman hyslology and ,echanlsms of
ulsease hlladelphla Saunders
W CuyLon AC Pall !L (1996) @exLbook of ,edlcal
hyslology hlladelphla Saunders
W hLLp//wwwbcbsmnfoundaLlonorg/ob[ecLs/ubllcaLlons/l
9789_web2020Wllder20companlon20plecepdf