HAP II Learning Objectives

Segment Three (Exam #3 is on Monday April 19, 2021)

Topic 17. Digestive System Histology / Upper GI Tract

(pp. 899-913)

24.1 Overview of the Digestive System

1. Distinguish between the components of the alimentary canal and the accessory digestive
organs. Describe each of the following aspects of digestive system function (pp. 899, 900:
Ingestion, secretion, mixing/propulsion, digestion (mechanical & chemical), absorption, and
defecation.
Components of the alimentary canal are from the esophagus to the rectum.
The accessory digestive organs are the salivary glands, liver, gallbladder, and pancreas.
Ingestion - the introduction and preliminary processing of food.
Secretion - water, ions, mucus, enzymes, etc., released by digestive organs.
Mixing/propulsion - smooth muscle contraction for mechanical breakdown of food and
transport (peristalsis) of digestion products.
Mechanical digestion - involves a change in the physical properties of food (size, temperature,
moistness) without breaking chemical bonds.
Chemical digestion - polymers (e.g. proteins) are broken down into their constituent
monomers (e.g. amino acids).
Absorption - water, ions, monomers, vitamins, etc. need to be transported from the lumen of
the digestive tract into the blood.
Defecation - Important excretion mechanism for elimination of wastes.
2. Be able to relate each of the functions listed in Objective #1 to the specific digestive system
structures that are responsible for them. (This will be developed in subsequent Topics)
Ingestion- mouth
Secretion - mouth, pharynx & esophagus, stomach, small intestine
Mixing/propulsion - mouth, stomach, small intestine
Mechanical digestion - mouth, stomach, small intestine
Chemical digestion - mouth, stomach, small intestine
Absorption - stomach, small intestine, large intestine
Defecation - rectum and anus
24.2 Layers of the GI Tract
3. Describe the four layers of the digestive tract (mucosa, submucosa, muscularis, and serosa)
and relate the special features of each to its functions (pp. 900, 901).
Mucosa - Made up of stratified squamous (in the mouth esophagus & anus) which helps it
stay durable and simple columnar (in the remaining GI tract) which helps secrete enzymes and
absorb nutrients. There are also specialized goblet cells to secrete mucous. Lamina propria is
also present which is a thin layer of loose connective tissue that contains blood vessels and
lymphatic tissue. There is also a muscularis mucosae which is a thin layer of smooth muscle
that causes folds to form in the mucosal layer and it increases local movements which
increases absorption with exposure to “new “ nutrients.
Submucosa - It is made up of loose connective tissue that contains blood vessels, glands, and
lymphatic tissues. A submucosal plexus is located here which acts as a parasympathetic
innervation. This plexus controls vasoconstriction and GI secretions.
 Muscularis - This is located in the mouth, pharynx, upper esophagus, and the anus. This
contains voluntary skeletal muscle. It helps control swallowing and defecation. There is also
involuntary smooth muscle as inner circular and outer longitudinal fibers that mix, crush, and
propel food along. There is also a myenteric plexus that has both parasympathetic and
sympathetic innervation of circular and longitudinal smooth muscle layers.
Serosa - This is serous membranes that cover all organs and walls of cavities not open to the
outside of the body. This secretes slippery fluid. It consists of connective tissue covered with
simple squamous epithelium. NOTE: this is also called the visceral layer of the parietal
peritoneum.
24.3 Neural Innervation of the GI Tract
4. Describe the neural innervation of the gastrointestinal tract, including the roles of the
enteric nervous system, autonomic nervous system, and gastrointestinal reflex pathways (p.
902).
The enteric nervous system contains sensory neurons that monitor chemical changes in
the GI tracts content and stretch the GI tracts walls and it contains motor neurons that regulate
contraction and secretion.
The autonomic nervous system controls smooth muscle motility and exocrine secretion. It
accomplishes this by a myenteric plexus (smooth muscle) and a submucosal plexus (glands).
The gastrointestinal reflex pathways are when a cause occurs which triggers an effect in
the gastrointestinal tract.
24.4 Peritoneum
5. Describe the anatomy of the peritoneum using the following terms (pp. 902-904):
A. parietal peritoneum, visceral peritoneum, serosa, retroperitoneal
The parietal layer of the peritoneum is the layer that lines the walls of body cavities.
The visceral peritoneum is the layer that covers the organs.
The serosa is a serous membrane that covers all organs and walls of cavities not open to
the outside of the body. It secretes a slippery fluid and is made up of connective tissue
covered with simple squamous epithelium. This is also called the visceral layer of the parietal
peritoneum.
The retroperitoneal is the area in the back of the abdomen behind the peritoneum. This is
the tissue that lines the abdominal wall and covers most of the organs in the abdomen.
B. peritoneal cavity
The peritoneal cavity is the potential space containing a bit of serous fluid.
C. greater omentum, lesser omentum, and falciform ligament
The greater omentum is the peritoneal fold that hangs down from the stomach over the
colon and small intestine.
The lesser omentum is the peritoneal fold that suspends the stomach and duodenum from
the liver.
The falciform ligament is a thin fibrous structure that connects the anterior part of the
liver to the ventral wall of the abdomen.
D. mesentery and mesocolon
The mesentery is a double-layered peritoneal fold that connects the small intestine to the
abdominal wall.
The mesocolon is a similar fold to the mesentery but it connects the colon to the
abdominal wall.
24.5 Mouth
24.6 Pharynx - A funnel-shaped tube extending from internal nares to the esophagus
posteriorly and larynx anteriorly.
6. Be able to describe the major structures of the oral cavity using a diagram such as Fig. 24.6,
p. 905.
Describe the major anatomical and functional features of the:
A. buccal cavity (labial frenulum, oral vestibule, palate, uvula) (p. 905)
The labial frenulum is used as an anchor. The oral vestibule is the cavity of the mouth.
There is a soft palate and hard palate in the oral cavity. During the pharyngeal stage, the soft
palate and the uvula are lifted to close off the nasopharynx.
B. salivary glands (amylase; parotid, sublingual, & submandibular glands; salivation)
(pp. 905-907)
Amylase begins starch digestion in the mouth with the pH of around 7. The parotid gland
is below your ear and over the masseter. The sublingual gland is deep to the tongue in the
floor of the mouth. The submandibular gland is under the lower edge of the mandible. All
these glands secrete saliva into ducts that empty into the oral cavity. The purpose of salivation
is to moisten food for easier swallowing and dissolving food for tasting.
C. tongue (extrinsic & intrinsic muscles; lingual frenulum; papillae, lingual lipase) (p.
908)
The extrinsic muscles of the tongue are attached to the hyoid, mandible, hard palate, and
styloid process. Intrinsic muscles are inside the tongue. Lingual frenulum acts as an anchor for
the tongue. Papillae are the bumps on the surface known for having the taste buds. These taste
buds are protected by being on the sides of the papillae. The lingual lipase catalyzes the first
phase of fat digestion. It is important in newborns but not so much in adults.
D. teeth (gingivae, periodontal ligament, dentin, enamel, cementum, mastication, types
of teeth: deciduous, permanent, incisors, canines, premolars, molars) (pp. 908-911)
Gingiva is the gum area. The periodontal ligament is found between the root part of the
tooth and the adjacent bone. It allows for pressure from chewing and grinding. Dentin is
calcified connective tissue. Enamel is the hardest substance in the body. It is made of calcium
phosphate or carbonate. Cementum is bone-like. The periodontal ligament penetrates the
cementum. Mastication is another word for chewing. Deciduous teeth are baby teeth. 20
deciduous teeth start erupting at 6 months. We have 32 permanent teeth that replace the baby
teeth. 8 incisors are made for cutting and snipping. 4 canines are made to tear and hold onto
food when it first enters the mouth. 8 premolars are initial short-term crushing teeth. 12
molars are four more extensive crushing (Only 8 molars if the wisdom teeth don’t erupt).
E. pharynx (pp. 911) - A funnel-shaped tube extending from internal nares to the
esophagus posteriorly and larynx anteriorly.
24.7 Esophagus - A collapsed muscular tube that lies in front of the vertebrae posterior to the
trachea and heart in which food travels.
24.8 Deglutition - Another word for swallowing that is facilitated by saliva and mucus.
7. Describe the major anatomical and functional features of the esophagus (esophageal hiatus;
upper and lower esophageal sphincters; adventitia: Describe the three stages of deglutition and
summarize the digestive activities that occur in the pharynx and esophagus. (pp. 911-913)
The esophageal hiatus transmits the esophagus, the vagus nerves, and some small
esophageal arteries. The upper sphincter relaxes when the larynx is lifted. The lower sphincter
relaxes as food approaches. Adventitia is connective tissue that blends with surrounding
connective tissue.
 Deglutition starts when bolus is pushed into the oropharynx. From there sensory nerves
send signals to the deglutition center in the brain stem. The soft palate is then lifted to close
the nasopharynx. And then the larynx is lifted as the epiglottis is spent to cover the glottis.
The pharynx assists in digestive activities because it connects the oral cavity to the
esophagus and the larynx. The esophagus is a collapsed muscular tube in which food travels.

Clinical connections: peritonitis (p. 903), mumps (p. 907), gastroesophageal reflux disease
(p. 913).
Peritonitis is the acute inflammation of the peritoneum caused by an infection from
surgery or a rupture of abdominal organs.
The mumps is a viral infection that affects the salivary glands. These glands will start to
swell.
Gastroesophageal reflux disease is when acid in the stomach begins to come back up the
esophagus usually due to an individual lying on their back.

Topic 18. Stomach, Exocrine Pancreas, & Liver (914-926)

24.9 Stomach
1. Summarize the anatomy, histology, and physiology of the stomach using the following
terms:
A. Anatomy - cardia, fundus, pylorus, rugae, and pyloric sphincter (distinguish between
pylorospasm and pyloric stenosis) (pp. 914-916).
Cardia-connects with esophagus
Fundus-superior most region of the stomach
Pylorus-connects with the duodenum of the small intestine
Rugae-make the stomach stretchable
Pyloric sphincter-band of smooth muscle that controls movement of digestive juices and foods
from pylorus to the duodenum
Pylorospasm-muscle fibers of sphincter fail to relax, trapping food in the stomach; vomiting
occurs to relieve pressure; treated with drug therapy
Pyloric stenosis-abnormally narrow sphincter results in projectile vomiting; must be corrected
surgically
B. Histology - mucosa (lamina propria, gastric pits/glands, mucous neck cells, chief cells,
parietal cells, enteroendocrine cells); submucosa, muscularis, serosa. (p. 916, 917)
Lamina propria- mucosa contains lamina propria, which is areolar connective tissue
Gastric pits/glands- epithelial cells extend down into lamina propria to form columns of
secretory cells called gastric glands; several glands open into the bottom of narrow channels
called gastric pits. Secretions from several gastric glands flow into each gastric pit and into
lumen of stomach
Mucous neck cells- secrete mucus
Chief cells- secrete pepsinogen and gastric lipase
Parietal cells- produce intrinsic factor (needed for absorption of B12) and HCl
Enteroendocrine cells- aka G Cell; located mainly in the pyloric antrum and secretes hormone
gastrin into bloodstream to stimulate gastric activity
C. Physiology (pp. 917-919)
i. Mechanical digestion – propulsion and retropulsion, formation of chyme, gastric
emptying
Propulsion-movement from the body to the antrum of the stomach
Retropulsion-movement from the pylorus back to the body
Formation of chyme-gentle mixing waves every 15 to 25 sec; mixes bolus with 2 quarts/day
of gastric juice to turn it into chyme (a thin liquid)
Gastric emptying-intense waves near the pylorus open the pyloric sphincter and squirt out 3
mL of chyme into duodenum with each wave. Takes up to 4 hours to empty
ii. Chemical digestion – proton pumps, pepsinogen/pepsin, gastric lipase. Roles of
specialized cells, as in Table 24.3.
Proton pumps- powered by H+ K+ ATPases actively transport H+ into the lumen while
bringing potassium ions (K+) into the cell. At the same time, Cl- and K+ diffuse out into the
lumen through Cl- and K+ channels in the apical membrane
Pepsinogen/pepsin-HCl from parietal cells transforms pepsinogen into pepsin (secreted by
chief cells) that breaks down peptide bonds between certain amino acids
Gastric lipase-fat digestion; gastric lipase splits the triglycerides in milk fat
iii. Absorption
Water (especially if it’s cold), electrolytes, some drugs (especially aspirin), alcohol. Meals
with high fat content slows the passage of alcohol from the stomach to the small intestine,
where absorption is more rapid.
24.10 Pancreas
2. Describe the anatomy & physiology of the exocrine pancreas using appropriate structural
and functional terms (pp. 920-922) - pancreatic duct, hepatopancreatic ampulla, acini,
pancreatic islets, contents of pancreatic juice (bicarbonate, amylase, proteinases [e.g., trypsin],
lipase, ribo- & deoxyribonuclease).
● Pancreatic duct- larger of the two ducts
● Hepatopancreatic ampulla- pancreatic duct joins the common bile duct from the liver and
gallbladder and enters the duodenum as a dilated common duct; opens on an elevation of
the duodenal mucosa known as the major duodenal papilla
● Acini- 99 % small clusters of glandular epithelial cells in pancreas; constitute the
exocrine portion of the organ. Secrete pancreatic juice
● Pancreatic islet cells- 1% of small clusters of glandular epithelial cells in pancreas;
secrete hormones glucagon, insulin, somatostatin, and pancreatic polypeptide
● Contents of pancreatic juice
○ Bicarbonate-gives pancreatic juice a slightly alkaline pH (7.1-8.2) that buffers
acidic gastric juice in chyme, stops action of pepsin from the stomach, and creates
proper pH for action of enzymes in small intestine
○ Amylase- starch-digesting enzyme
○ Proteinases- enzymes that hydrolyze peptide bonds in proteins
○ Lipase- a pancreatic enzyme that catalyzes the breakdown of fats to fatty acids
and glycerol or other alcohols
○ Ribo/deoxyribonuclease- digest nucleic acids and deoxyribonucleic acid into
nucleotides

24.11 Liver and Gallbladder

3. Describe the anatomy & physiology of the liver and gallbladder using the following
structural and functional terms (pp. 922-926)
a. Liver
 i. Anatomy - left and right lobes separated by the falciform ligament
Sickle shaped ligament attaches the anterior surface of the liver to the anterior abdominal wall
and forms anatomical division between left and right lobes of the liver
ii. Histology - hepatocytes, hepatic laminae, , hepatic macrophages, portal triad,
hepatic acinus
Hepatocytes-arranged in lobules; perform wide array of metabolic, secretory, and endocrine
functions
Hepatic laminae- plates of hepatocytes one cell thick bordered on either side by endothelial-
lined vascular sinusoid spaces; highly branched and irregular structures
Hepatic macrophages-Destroy worn-out white and red blood cells, bacteria, and other foreign
matter in the venous blood draining from the GI tract
Portal triad-Branches of the hepatic artery, vein, and bile ducts
Hepatic acinus-The preferred structural and functional unit of the liver is the hepatic acinus.
Each hepatic acinus is an approximately oval mass that includes portions of two neighboring
hepatic lobules. It is defined by branches of the portal triad.
iii. Relationship with gallbladder - bile; bile canaliculi, ductules, and ducts;
common hepatic duct
Bile-synthesis of bile salts and plasma proteins from liver and gallbladder
Bile canaliculi- Small ducts between hepatocytes that collect bile produced by the hepatocyte
Ductules-Bile passes into bile ductules
Ducts-Bile from bile duct tools enter bile ducts. The ducts merge and eventually form the
right and left hepatic ducts, which unites and exit the liver as the common hepatic duct
Common hepatic duct-joins the cystic duct from the gallbladder to form the common bile
duct.
iv. Blood supply – hepatic artery, hepatic portal vein, sinusoids
Hepatic artery-Oxygenated blood
Hepatic portal vein-Nutrient-rich deoxygenated blood
Sinusoids-Highly permeable blood capillaries between rows of hepatocytes
b. Gallbladder – components and functions of bile, cystic duct, and common bile duct
Components/functions of bile-aid in the digestion of fats in the duodenum. Bile is
composed of bile acids and salts, phospholipids, cholesterol, pigments, water, and electrolyte
chemicals that keep the total solution slightly alkaline
Cystic duct-From the gallbladder, this joins the common hepatic duct to form the common
bile duct
Common bile duct-Bile enters the duodenum of the small intestine to participate in digestion
4. Briefly summarize each the following functions of the liver and gallbladder (p. 926):
a. Metabolism of carbohydrates, lipids, and proteins
Carbohydrate metabolism-convert amino acids and triglycerides into glucose
(gluconeogenesis), convert excess glucose into glycogen and store in the liver, convert
glycogen back into glucose and release into the blood as needed
Lipid metabolism-synthesize cholesterol, synthesize lipoproteins (HDL and LDL)(used to
transport fatty acids in the bloodstream), stores some fat, breaks down some fatty acids
Protein metabolism-deamination (remove amine group from amino acids so liver can use what
is left as an energy source); converts toxic ammonia resulting from deamination into urea for
renal excretion; synthesizes plasma proteins utilized in the clotting mechanism, immune
system defense and lipid transport; interconversion of amino acids.
b. Detoxification/alteration of drugs and hormones
Detoxifies the blood by removing or altering drugs and hormones. It can turn these into bile
and also chemically alter or excrete thyroid hormones and steroid hormones such as estrogen
and aldosterone.
c. Bilirubin excretion
Bilirubin, derived from the heme of aged red blood cells, is absorbed by the liver from the
blood and secreted into bile. Most of the bilirubin and bile is metabolized in the small
intestine by bacteria and eliminated in feces
d. Synthesis of plasma proteins and bile salts
Bile salts are used in the small intestine for the emulsification and absorption of lipids
e. Storage of glycogen, vitamins, and minerals
The liver is a prime storage site for certain vitamins (A, B12, D, E, K) and minerals (iron and
copper), which are released from the liver when needed elsewhere in the body
f. Phagocytosis of blood cells & bacteria
The stellate reticuloendothelial cells (Kupffer) of the liver phagocytizes aged red blood cells,
white blood cells and some bacteria.
g. Activation of vitamin D (cholecalciferol)
The skin, liver, and kidneys participate in synthesizing the active form of vitamin D
Clinical Connections: pancreatitis and pancreatic cancer (p. 922), jaundice (p. 925),
gallstones (p. 926)
Topic 19. Small Intestine
(pp. 809-811, 927-936)
24.12 Small Intestine
1. Describe the gross anatomy and histology of the small intestine (pp. 927-931).
Gross Anatomy - duodenum, jejunum, ileum, ileocecal sphincter, circular folds.
Histology – absorptive cells, goblet cells, intestinal glands, Paneth cells, enteroendocrine
cells (S, CCK, and K), solitary and aggregated lymphatic nodules, duodenal glands, circular
folds, villi, lacteal, microvilli, brush border, and brush-border enzymes.
2. Almost all of the chemical digestion and absorption of nutrients occurs in the small
intestine. Explain this fact in terms of the following physiological processes:
A. Role of intestinal juice and brush-border enzymes (p. 930)
B. Mechanical digestion (segmentations, intestinal peristalsis (MMC)) (p. 931)
C. Chemical digestion (carbohydrates, proteins, lipids, and nucleic acids) (pp. 931, 932).
D. Absorption (carbohydrate, protein, lipid [see next objective]), water, electrolytes, and
vitamins. (pp. 932, 933) (See Figure 24.22 p. 933.)
3. Describe the role played by each of the following in lipid absorption and transport: bile
salts, micelles, enterohepatic circulation, intracellular lipase, chylomicrons, lipoprotein lipase,
and lipoproteins. (pp. 933-935). Relate the overall process of intestinal lipid absorption to the
functional anatomy of the lymphatic system (pp. 809-811).

Clinical Connections: lactose intolerance (p. 931), absorption of alcohol (p. 936)

Topic 20. Large Intestine / Phases of Digestion

(pp. 936-949)
24.13 Large Intestine
1. Describe the gross anatomy, histology, and pathology of the large intestine. (pp. 936-939)
 A. Gross Anatomy – mesocolon, ileocecal sphincter, cecum, appendix, colon
(ascending, transverse, descending, sigmoid) rectum, anal canal and columns
Mesocolon - This connects the abdominal cavity and the pelvis.
Ileocecal Sphincter - This is relaxed by the gastrin that is being produced by the stomach
filling so that the small intestine will empty and make room for new chyme.
Cecum - receives chyme from the ilium via the ileocecal valve.
Appendix - The vermiform appendix contains large amounts of lymphatic tissue.
Colon - The colon has four sections : ascending colon (right side), descending colon (left
side), transverse, and sigmoid (this connects with the rectum at the midline).
Rectum - The last 8 inches of the GI tract. It is anterior to the sacrum and coccyx.
Anal canal - The last 1 inch of the GI tract. It contains an internal sphincter which is
involuntary smooth muscle and an external sphincter which is voluntary skeletal muscle.
B. Histology - mucosa (goblet & absorptive cells), submucosa, muscularis (teniae coli,
haustra), serosa, and epiploic appendages
Mucosa (goblet & absorptive cells) - There is a mucosa layer that is made of simple
columnar cells to absorb water and goblet cells to secrete mucus.
Submucosa - There is also a submucosa layer that contains lymphatic nodules (the
mucosa layer has these as well).
Muscularis - There is an internal circular layer. And then there is an outer longitudinal
layer. Within this muscle are taeniae coli which are shorter bands and there are haustra formed
which are pouches.
Serosa - visceral peritoneum
Epiploic appendages - These are also found in the outer longitudinal muscle.
2. Describe digestive processes in the large intestine (pp. 939-941).
Mechanical Digestion - gastroileal reflex, haustral churning, mass peristalsis, gastrocolic
reflex
Mechanical digestion deals with smooth muscle.
Gastroileal reflex - while the stomach is filling, it releases gastrin. This will relax the
ileocecal sphincter so that the small intestine will empty.
Haustral churning - relaxed pouches are filled from below by muscular contractions.
Gastrocolic reflex - when the stomach fills, a strong peristaltic wave moves contents of
transverse colon into rectum.
Chemical Digestion, Absorption, and Feces Formation
During chemical digestion, there are no enzymes secreted, only mucus. Carbohydrates
decompose into CO2 and methane gas. Proteins transform into indoles (these have an
offensive odor). Bilirubin is turned into urobilin and stercobilin (these produce color).
Bacteria produce vitamin K and B in the colon.
During absorption and feces formation, electrolytes are absorbed. Most of H2O is
removed from the chyme. Feces are semisolid when they reach the transverse colon. The feces
is made up of dead epithelial cells, undigested food such as cellulose, and bacteria.
Defecation Reflex
During defecation, the gastrocolic reflex moves feces into the rectum. Stretch receptors
signal the sacral spinal cord. Parasympathetic nerves contract muscles of the rectum and relax
the internal anal sphincter. Then, the external sphincter is controlled voluntarily to empty the
rectum
 3. Describe the causes and effects of diarrhea and constipation. Explain the benefits of a diet
high in fiber (soluble and insoluble). (pp. 941, 942)
Diarrhea is when chyme passes too quickly and has too much H2O. This can be caused
by viral infections, bacterial toxins, and spicy food. These things irritate the smooth muscle.
Constipation is a decreased intestinal motility. This is when too much water has been
absorbed from the feces which makes it difficult to evacuate the stool. Remedies for this includes
fiber, exercise, and increased water intake.
Insoluble Fiber is the woody part of plants. It speeds up transit time and reduces colon
cancer.
Soluble Fiber is a gel-like consistency from foods such as beans, oats, and apples. It
lowers blood cholesterol by preventing reabsorption of bile salts so the liver has to use
cholesterol to make more.
24.14 Phases of Digestion
4. Describe the three phases of digestion and the major hormones that regulate each phase (see
Table 24.8) (pp. 942-944)
A. Cephalic phase – salivary and gastric secretions - this stage is when the
stomach is getting ready for food. The cerebral cortex senses food through sight, smell, etc.
The vagus nerve increases stomach muscles and glandular activity.
B. Gastric phase – neural and hormonal regulation - this stage is when the
stomach is working. The nervous system control keeps the stomach alive. The digestion
process is aided by stretch receptors and chemoreceptors signaled by the nervous system. The
endocrine system influences stomach activity. Gastrin is released to help the digestion process
occur.
C. Intestinal phase - neural (enterogastric reflex) and hormonal regulation - this is
when the stomach is emptying. Stretch receptors slow stomach activity and increase intestinal
activity. Fatty acids or glucose signals the medulla. The sympathetic nerves slow stomach
activity. The intestinal hormones released are secretin which decreases stomach secretions and
cholecystokinin which decreases stomach emptying.

Note: We are not covering 24.15 Development of the Digestive System

5. Distinguish between the following types of intestinal pathology – diverticular disease (p.
946), colorectal cancer (p. 946), inflammatory bowel disease (Crohn’s and ulcerative colitis)
(p. 949), irritable bowel syndrome (p. 949), celiac disease (not in text).
Diverticular disease - pouches form in the walls of the colon. This can be aggravated by a
low fiber diet.
Colorectal cancer - This develops from polyps. Hereditary, diet, and alcohol intake can
all be contributing factors. A colonoscopy can detect this.
Inflammatory bowel disease - a structural disease that can cause damage to the intestinal
lining. Crohn's disease and ulcerative colitis can develop from this.
Irritable bowel syndrome - a functional disease that will not cause long term damage.
Celiac disease - a hereditary autoimmune disease of the small intestine. It can be
triggered by gluten in wheat, rye, or barley.

Clinical Connections: appendicitis (p. 938), polyps in the colon (p. 939), occult blood (p.
941), colonoscopy (p. 948)
Appendicitis - an inflamed appendix that can eventually burst, spilling infectious
materials into the abdominal cavity. Removal of the appendix is usually required.
 Polyps in the colon - Colon cancer can develop from having these precancerous polyps in
the colon. Removal is required to avoid cancer.
Occult blood - This is when blood is present in the feces. This is a sign of polyps that
could cause cancer. Doctors can request for an occult blood test from a feces sample.
Colonoscopy - A colonoscopy is a camera that is thread through the anus while the
patient is asleep or twilighted. This camera takes snapshots to see if there are any polyps or
anything else that should not be there.

Topic 21. Metabolic Reactions/Carbohydrate Metabolism

(pp. 953-965)
25.1 Metabolic Reactions
1. Describe how catabolism and anabolism are linked by ATP, as illustrated in Figure 25.1, p.
954. What percentage of energy released in catabolism is ultimately lost as heat? (pp. 953,
954)
Catabolic reactions break down complex organic compounds to provide energy (exergonic).
Happens through glycolysis, Krebs cycle, electron transport. Anabolic reactions synthesize
complex molecules from small molecules. It requires energy (endergonic) The exchange of
energy requires use of ATP. Over 50% of the energy released from ATP is converted to heat.
25.2 Energy Transfer
2. Evaluate the metabolic purpose and significance of oxidation-reduction reactions. What
roles are played by the coenzymes NAD+ and FAD? (p. 955)
Oxidation reactions require coenzymes NAD and FAD to accept electrons from another
compound. NADH transfers electrons to the Cytochrome complex I during oxidative
phosphorylation. FADH2 transfers its electrons to Cytochrome complex II during oxidative
phosphorylation.
3. Summarize the two mechanisms of ATP generation that occur in humans (substrate-level
and oxidative phosphorylation). Name and describe the method that occurs only in
chlorophyll-containing organisms. (pp. 955, 956)
Substrate level phosphorylation-Generates ATP by transferring a high-energy phosphate
group from an intermediate phosphorylated metabolic compound directly to ADP. This occurs
in the cytosol
Oxidative phosphorylation occurs in the mitochondria. It is the formation of covalent bonds
attaching the 3rd phosphate group; it contains stored energy. This occurs in the mitochondrial
membrane of cells
In chlorophyll-containing plants or bacteria, photophosphorylation occurs.
25.3 Carbohydrate Metabolism
4. Describe four potential metabolic fates of glucose after it is absorbed by the digestive
system. How does glucose enter different types of cells (via secondary active transport,
insulin-dependent GluT4, or hepatocyte/neuron GluT)? (p. 956, see also pp. 67, 71)
1. ATP production during cell respiration-cells use glucose preferentially; some will switch
to other fuels as circumstances warrant
2. Glucose can be converted to one of several amino acids
3. Glycogenesis-hundreds of glucose molecules are combined to form glycogen for storage
in liver and skeletal muscles
4. Lipogenesis (triglyceride synthesis)-glucose can be converted into glycerol and fatty
acids within the liver and then transported in the blood for storage in adipocytes
Glucose absorption in the GI tract is accomplished via secondary active transport through
sodium-glucose importers. glucose entry into most other body cells occurs via gluT molecules, a
family of transporters that bring glucose into cells via facilitated diffusion. A high level of
insulin increases the insertion of one type of gluT called gluT4 into the plasma membranes of
most body cells. This increases the rate of facilitated diffusion of glucose into cells.
GlutT4 is activated by higher insulin levels; also activated in skeletal muscles by exercise.
5. Summarize the overall process of glucose catabolism for generation of ATP, as illustrated
in Figure 25.2 on p. 956. Describe the roles played by each of the following:
nicotinamide adenine dinucleotide (NAD+) (pp. 955, 959-963)-A derivative of the B vitamin
niacin (a coenzyme). When reduced NAD gains a hydride ion, neutralizing its charge, in the
hydrogen ion is released into the surrounding solution
flavin adenine dinucleotide (FAD) (pp. 955, 959, 961)-A derivative of vitamin B2
(riboflavin).
pyruvic acid (pp. 958-960)-If oxygen is scarce then pyruvic acid is reduced via an anaerobic
pathway by the addition of two hydrogen atoms to form lactic acid. This allows glycolysis to
continue, and as lactic acid is produced it rapidly diffuses out of the cell and enters the blood.
Hepatocyte to remove lactic acid from the blood and convert it back to pyruvic acid. When
oxygen is plentiful, most cells convert pyruvic acid to acetyl coenzyme a. Is molecule links
glycolysis with the Krebs cycle
phosphorylation (pp. 955-962)-The addition of a phosphate group to a molecule is
phosphorylation. it increases the potential energy to generate ATP
glycolysis (pp. 956-959)-During glycolysis, chemical reaction split a six carbon molecule of
glucose into two three-carbon molecules of pyruvic acid. It consumes 2 ATP molecules and
produces 4 ATP molecules for a net gain of 2 ATP molecules for each glucose molecule
oxidized.
acetyl coenzyme A (pp. 956, 959, 960)-A transition step that prepares pyruvic acid for
entrance into the Krebs cycle is the formation of acetyl coenzyme a. The step also produces
energy containing NADH and hydrogen ions plus carbon dioxide
Krebs cycle (pp. 959, 960)-Also known as the citric acid cycle, the reactions occur in the
matrix of the mitochondria and consists of a series of oxidation reduction reactions and
decarboxylation reactions that release carbon dioxide. In the krebs cycle, the oxidation
reduction reactions transfer chemical energy in the form of electrons to coenzymes NAD and
FAD. One step also generates ATP.
electron transport chain (pp. 960-963)-A series of electron carriers, integral membrane
proteins in the inner mitochondrial membrane. This membrane is folded into a cristae that
increases its surface area to accommodate thousands of copies of the transport chain in each
mitochondria. As electrons pass through the chain, a series of exergonic reactions release
small amounts of energy to form ATP

Note that you are not expected to describe the detailed enzymatic pathways illustrated in
Figures 25.4 (p. 959), 25.7 (p. 960) or 25.9 (p. 962). Useful summaries of what you should
know can be found in Figures 25.2 (p. 956), 25.3 (p. 957), 25.5 (p. 959), 25.6 (p. 960), and
25.10 (p. 963). See also Table 25.2: Summary of Metabolism (p. 972)

6. Define and discuss the significance of glycogenesis, glycogenolysis and gluconeogenesis.

(pp. 963-965).
Glycogenesis-(stimulated by insulin) glucose storage as glycogen; 4 steps to glycogen
formation in liver or skeletal muscle
Glycogenolysis-(stimulated by glucagon and epinephrine) glucose release is not a simple
reversal of steps; phosphorylase splits off a glucose molecule by phosphorylation to form
glucose 1-phosphate; phosphorylase enzyme is present only in hepatocytes, so muscle cells
cannot release glucose obtained from glycogen into the blood, but must use it for their own
energy needs
Gluconeogenesis-liver glycogen runs low if fasting, starving, or not eating carbohydrates,
forcing formation from other substances (lactic acid, glycerol, and certain amino acids).
Stimulated by cortisol (adrenal) and glucagon (pancreas). Cortisol stimulates breakdown of
proteins, freeing amino acids. Thyroid mobilizes triglycerides from adipose tissue

Topic 22. Lipid & Protein Metabolism/Metabolic Adaptations

(pp. 46-49, 966-970)

25.4 Lipid Metabolism

1. Describe and distinguish between the following kinds of lipids:
A. Triglycerides – saturated, monounsaturated, and polyunsaturated fats (pp. 46-49)
B. Trans fats (p. 49, see third paragraph in Clinical Connection box)
C. Essential fatty acids (pp. 967; also read this article LINK)
2. Explain the purpose of lipoproteins. Distinguish between the lipid transport roles played by
chylomicrons, VLDLs, LDLs, and HDLs. What is the metabolic fate of each? (pp. 966, 967)
3. Describe the sources and significance of blood cholesterol and the therapies used to lower
it. Discuss the disease risks when each of the following is abnormally high: total cholesterol,
LDL-cholesterol, and ratio of total cholesterol to HDL-cholesterol. Summarize the metabolic
fates of lipids and describe the storage of triglycerides in different body regions. (p. 967)
4. Describe the processes of lipid catabolism (lipolysis) and lipid anabolism (lipogenesis),
discussing the significance of: epinephrine, norepinephrine, insulin, glyceraldehyde 3-
phosphate, beta oxidation, ketogenesis, fates of ketone bodies, glycerol & fatty acid formation
(pp. 967-969). Note the summary in Figure 25.14 on p. 967.
25.5 Protein Metabolism
5. Summarize each of the following aspects of protein metabolism (pp. 969, 970):
protein catabolism (deamination, entrance into the Krebs cycle [see Figure 25.15, p. 969])
protein anabolism (essential and nonessential amino acids, transamination).
25.6 Key Molecules at Metabolic Crossroads
6. Summarize the key metabolic roles played by glucose 6-phosphate, pyruvic acid, and acetyl
coenzyme A, as illustrated in Figure 25.16, p. 971 (pp. 971, 972).
25.7 Metabolic Adaptions
7. Describe the different regulatory strategies used to maintain availability of glucose to
tissues during the absorptive and postabsorptive states, as summarized in Figure 25.17 (p.
973) and Figure 25.18 (p. 975). Summarize metabolic adaptations that occur during fasting
and starvation. (pp. 972-976)

Topic 23. Heat & Energy Balance/Principles of Nutrition

(pp. 971-988)

25.8 Energy Balance

1. Summarize each aspect of heat and energy homeostasis listed below (pp. 977-980):
Food calories – energy content in kilocalories (pp. 977, 978)
A kilocalorie is the amount of energy required to raise the temperature of 1 gram water from
25 degrees C to 26 degrees C.
Metabolic rate – factors that affect it, BMR, TMR, NEAT, food-induced thermogenesis (p.
979)
Metabolic rate is the rate at which all of the body’s metabolic reactions burn calories.
Basal metabolic rate (BMR) - measurements made under specific conditions.
The basal temperature is maintained at 98.6 F (core temp).
Stored chemical energy (p. 979)
Stored chemical energy is what is stored to be converted into glucose and into body fat.
Calories are twice as efficient at being converted into body fat as calories from protein.
Regulation of food intake – satiety and adiposity, interactions between leptin,
neuropeptide Y, melanocortin, and ghrelin (pp. 979. 980)
Satiety - the feeling of fullness and having no desire to eat
Leptin has to do with long term feeding. Adipocytes make leptin at a constant rate which
causes leptin levels to be proportional to fat stored.
Glucose has to do with short term feeding.
Leptin inhibits hypothalamic release of neuropeptide Y (which increases feeding) and
stimulates the release of melanocortin (which inhibits feeding).
Ghrelin increases appetite.
25.9 Regulation of Body Temperature
2. Discuss the following aspects of body temperature homeostasis (pp. 980-983)
Heat production – core and shell temperatures
The core temperature must be maintained in the healthy range to avoid complications and
death. Shell temperature is usually 1 to 6 degrees lower than 98.6 F (the ideal core
temperature).
Mechanisms of heat transfer – conduction, convection, radiation, evaporation
(including insensible water loss)
Conduction - is heat exchange requiring direct contact with an object
Convection - is heat transfer by the movement of gas or liquid over the body
Radiation - is transfer of heat in form of infrared Rays from body
Evaporation - is heat lost due to conversion of liquid to vapor
Hypothalamic Thermostat &Thermoregulation – preoptic area, heat-losing and heat-
promoting areas, sympathetic nervous system, thyroid hormone
The preoptic area is in the anterior hypothalamus. It receives impulses from thermoreceptors,
generates impulses at a higher frequency when blood temperature increases, and impulses
propagates other parts of the hypothalamus (the heat-losing center and heat-promoting center)
Sympathetic nervous system releases epinephrine and norepinephrine which increases BMR.
Thermoreceptors signal for the release of thyroid hormone. Thyroid hormone causes
vasoconstriction in the skin, shivering, and increases in metabolic rate.
25.10 Nutrition
3. Describe the guidelines for a healthy diet. Discuss the purpose and recommendations of
MyPlate.gov (Fig. 25.20). Distinguish between foods that are calorie-dense and nutrient-
dense. (pp. 983, 984)
The healthy plate indicates the number of servings of each food group to eat each day.
Grains is the largest area of the plate/pyramid.
4. Summarize the roles played by minerals and vitamins in human physiology. Summarize the
importance/function, as listed in Tables 25.9 (p. 984) and 25.10 (p. 986), of the following
selected minerals and vitamins: calcium, phosphorus, potassium, sodium, and iodide.
Vitamins: A, D, E, K, thiamine, riboflavin, nicotinamide, cyanocobalamin, folic acid, C
(ascorbic acid). Distinguish in general between fat-soluble and water-soluble vitamins.
Calcium and phosphorus form part of the matrix of bone. Potassium is a neuron/muscle action
potential. Sodium has the role of water balance buffering, neuron/muscle action potentials.
Iodide has the role of being a necessary constituent of thyroid hormone.
Vitamin A is a precursor for the retinal synthesis and the photoreceptors of the eye; it
regulates osteoblast and osteoclast activity. Vitamin D stimulates calcium absorption by the
GI tract. Vitamin E stabilizes cell membranes, promotes wound healing, and antioxidants.
Vitamin K is a cofactor for synthesis of prothrombin and other clotting factors. Thiamine is a
coenzyme for glucose catabolism and acetylcholine synthesis. Riboflavin is a component of
FAD. Nicotinamide is a component of NAD. Cyanocobalamin is a coenzyme for
erythropoiesis, required insertion of amino acids into the Krebs cycle. Folic acid is required
for synthesis of DNA, RNA, RBC's, and WBC’s. Ascorbic acid is a coenzyme for collagen
synthesis, and is an antioxidant.
Fat soluble vitamins are absorbed with dietary fats by the small intestine. It is stored in the
liver and includes vitamins A, D, E, and K. Water soluble vitamins are absorbed along with
water in the GI tract. The body does not store these, instead it excretes the excess in urine.
Water soluble vitamins include B vitamins and vitamin C.

Disorders: Homeostatic Imbalances

5. Discuss the pathophysiology and treatment of the following conditions (pp. 987, 988):
Fever – roles of pyrogens and prostaglandins, chills (rising phase), crisis phase
A fever is in the abnormally high body temperature due to toxins from bacterial or viral
infection called pyrogens.
Obesity – definition, contributing factors, treatment
Obesity is when an individual has body weight more than 20% above desirable standard.
Many risk factors include cardiovascular disease, hypertension, varicose veins, gallbladder
disease, certain cancers, and Pulmonary Disease.
Miscellaneous disorders – anorexia & bulimia nervosa, kwashiorkor, marasmus
Anorexia is the relentless pursuit of thinness and unwillingness to maintain a normal or
healthy weight. Bulimia is frequent episodes of binge eating large amounts of food and
feeling a lack of control over eating. Marasmus is a severe calorie deficiency. Kwashiorkor is
a protein deficiency but overall calories may be adequate.

Topic 24. Anatomy of the Kidneys (pp. 994-1004)

26.1 Overview of the Urinary System
1. Briefly describe each of the following functions of the kidneys (pp. 994, 995):
Regulation of the blood – ionic composition, osmolarity, volume, pressure, pH, glucose
concentration (through gluconeogenesis)
Ionic composition- Kidneys help regulate the blood levels of several ions, most importantly
sodium ions, potassium ions, calcium ions, chloride ions, and phosphate ions. The kidneys
accomplish this task by adjusting the amounts of these ions excreted into the urine
Osmolarity- By separately regulating loss of water and loss of solutes in the urine, the kidneys
maintain a relatively constant blood osmolarity close to 300 milliosmoles per liter
Volume-The kidneys adjust blood volume by conserving or eliminating water in the urine. An
increase in blood volume increases blood pressure. A decrease in blood volume decreases
blood pressure
Pressure-The kidneys also help regulate blood pressure by secreting the enzyme renin, which
activates the renin-angiotensin-aldosterone pathway. Increase renin causes an increase in
blood pressure
pH-The kidneys excrete a variable amount of hydrogen ions into the urine and conserve
bicarbonate ions, which are an important buffer of hydrogen ions in the blood. Both of these
activities help regulate blood pH
Glucose concentration-Like the liver, the kidneys can use the amino acid glutamine and
gluconeogenesis, the synthesis of new glucose molecules. They can then release glucose into
the blood to help maintain a normal blood glucose level
Production of hormones - calcitriol, erythropoietin
The kidneys produce two hormones. Calcitriol, the active form of vitamin D, helps regulate
calcium homeostasis, and erythropoietin stimulates the production of red blood cells
Waste excretion – endogenous products of metabolic reactions, foreign (exogenous)
substances
By forming urine, the kidneys help excrete waste from the body. Some waste excreted in
urine results from metabolic reactions. These include urea and ammonia from the deamination
of amino acids; creatine from the breakdown of creatine phosphate; uric acid from the
catabolism of nucleic acids; and urobilin from the breakdown of hemoglobin. All of these are
collectively known as nitrogenous waste because they are waste products that contain
nitrogen. Other waste excreted in the urine or foreign substances that have entered the body,
such as drugs and environmental toxins
26.2 Anatomy of the Kidneys
2. Describe the external and internal gross anatomy of the kidneys. Specifically, be able to
describe the: (pp. 995-999):
Renal hilus – access site for ureter, nerves, blood and lymphatic vessels
The ureter emerges from the kidney along with the blood vessels, lymphatic vessels, and
nerves near the center of the concave border of the kidneys
External support structures - renal capsule, adipose capsule, renal fascia,
Renal capsule-Smooth, transparent sheet of dense irregular connective tissue that is
continuous with the outer coat of the ureter. It serves as a barrier against trauma and helps
maintain the shape of the kidney
Adipose capsule-Mass of fatty tissue surrounding the renal capsule. It also protects the kidney
from trauma and hold it firmly in place within the abdominal cavity
Renal fascia-The Superficial layer, another thin layer of dense irregular connective tissue that
anchors the kidney to the surrounding structures into the abdominal wall. This is deep to the
peritoneum
Internal gross anatomy - renal cortex, renal medulla, renal pyramids, renal papillae
Renal cortex-Superficial, light red region extending from the renal capsule to the base of the
renal pyramids and into the spaces between them. It is divided into an outer cortical Zone and
an inner just two medullary Zone
Renal medulla-Deep, Dark red-brown Inner region that consists of several cone-shaped renal
pyramids. Together, the renal cortex and renal pyramids of the renal medulla constitute the
parenchyma, or the functional portion of the kidney
Renal pyramids-The base, the wider end of each pyramid, faces the renal cortex, and its apex,
which is the narrower end, is called a renal papilla and points toward the renal hilum.
Route of urine flow from papillary ducts to bladder
Filtrate formed by nephrons drains into papillary ducts which extend from the renal papillae
of the pyramids. Papillary ducts drain into cuplike structures called minor and major calyces.
A minor calyx receives filtrate from the papillary ducts of one renal papillae and delivers it to
a major calyx. Once filtrate enters the calyces it becomes urine because no further
reabsorption can occur. From major calyces, urine drains into a single large cavity called the
renal pelvis and through the ureter to the urinary bladder.
Route of blood flow from renal artery to renal vein.
The renal artery divides into segmental arteries which supply different segments of the
kidney. Each segmental artery gives off several branches that enter the parenchyma and pass
through the renal column between the renal lobes as the interlobular arteries. At the base of
renal pyramids, the interlobular arteries arch between the renal medulla and cortex as the
arcuate arteries Divisions produce cortical arteries that radiate outward and enter the renal
cortex, giving off afferent arterioles. Each nephron receives one afferent arteriole which
divides into the glomerulus. The glomerular capillaries reunite to form an efferent arteriole
that carries blood out of the glomerulus. Efferent arterioles divide to form the peritubular
capillaries which surround the tubular parts of the nephron in the renal cortex. Vasa recta
supply in the renal medulla. Peritubular capillaries reunite to form the cortical radiate veins
which also receive blood from the vasa recta. Blood drains through the arcuate veins to the
interlobular veins. Blood leaves the kidney through a single renal vein that exits through the
renal hilum.
26.3 The Nephron
3. Describe the anatomy of the nephron (pp. 999-1004). Specifically, be able to describe the:
Renal corpuscle – glomerulus, glomerular capsule.
Glomerulus-capillary network
Glomerular capsule-double walled epithelial cup that surrounds the glomerular capillaries
Renal tubule – proximal convoluted tubules, nephron loop, distal convoluted tubule
Proximal-denotes the part of the tubule attached to the glomerular capsule
Distal-part that is farther away
Convoluted-means the tubule is is tightly coiled rather than straight
The renal corpuscle and both convoluted tubules lie within the renal cortex; the nephron loop
extends into the renal medulla, makes a hairpin turn and returns to the renal cortex.
Route of urine flow from the proximal convoluted tubule to the papillary ducts
The distal convoluted tubules of several nephrons empty into a single collecting duct.
Collecting ducts unite and converge into several hundred large papillary ducts, which drain
into the minor calyces,
Cortical and juxtamedullary nephrons
Cortical nephrons-renal corpuscles lie in the outer portion of the renal cortex and have short
nephron loops that lie mainly in the cortex and penetrate only into the outer region of the renal
medulla
Juxtamedullary nephrons-renal corpuscles lie deep in the cortex, close to the medulla, and
they have a long nephron loop that extends into the deepest region of the medulla. Long
nephron loops receive their blood supply from peritubular capillaries and from the vasa recta
that arise from efferent arterioles.
Histology – podocytes, cuboidal and squamous epithelial cells, juxtaglomerular cells,
principal cells, intercalated cells
Podocytes-visceral layer consists of modified simple squamous epithelium. The many footlike
projections of these cells wrap around the single layer of endothelial cells of the glomerular
capillaries and form the inner wall of the capsule.
Juxtaglomerular cells-the wall of the afferent arteriole contains modified smooth muscle
fibers called JG cells. With the macula densa, the constitute the juxtaglomerular apparatus
Principal cells-have receptors for both antidiuretic hormone and aldosterone
Intercalated discs play a role in the homeostasis of blood pH

Clinical connection: nephroptosis (p. 995)

Topic 25. Renal Physiology I (pp. 1004-1015)

26.4 Overview of Renal Physiology

1. Define the processes of glomerular filtration, tubular reabsorption, and tubular secretion.
Explain their relationships to each other. Distinguish between presumptive urine and
definitive urine. (pp. 1004, 1005)
26.5 Glomerular Filtration
2. Describe glomerular filtration using the following terms (pp. 1006-1008):
a. Glomerular filtrate and filtration fraction (p. 1006)
b. Filtration membrane (contains 3 filtration layers – fenestrated glomerular endothelial cells
[with mesangial cells], basal lamina, podocyte/pedicel filtration slits) (pp. 1006, 1007)
c. Glomerular capillary surface area & blood pressure – note differences between
glomerular capillaries and other capillaries in the body (see Figure 21.4, p. 743) (p. 1007).
d. Net filtration pressure (GBHP – CHP – BCOP; compare Figure 26.9, p. 1007, with
filtration at the arterial end of a capillary, as in Figure 21.7, p. 747. It’s the same principle:
Starling’s law of the capillary.) (pp. 1007, 1008)
e. Glomerular filtration rate (GFR; Q: What happens to GFR if GBHP falls to 45 mm Hg or
less?) (pp. 1008)
3. Describe the following aspects of regulation of the glomerular filtration rate (GFR)
(pp. 1008-1010)
a. Renal autoregulation of GFR (myogenic mechanism, tubuloglomerular feedback)
b. Neural regulation of GFR (sympathetic control decreases GFR)
c. Hormonal regulation of GFR (Angiotensin II decreases GFR, atrial natriuretic peptide
increases GFR)
26.6. Tubular Reabsorption and Tubular Secretion
4. Discuss the following aspects of tubular reabsorption (pp. 1010-1012):
a. Reabsorption routes (paracellular reabsorption, transcellular reabsorption)
b. Transport mechanisms (apical diffusion of Na+, basolateral active transport of Na+,
transport maximum, obligatory water reabsorption, and facultative water reabsorption)
5. Account for the overall reabsorption and/or secretion in the nephron tubule of each of the
following (pp. 1012-1015): sodium (Na+) glucose and other nutrients, water, hydrogen ion
(H+), bicarbonate ion (HCO3- ), other electrolytes. (See the summary in Fig. 26.20, p. 1021).
Pay special attention to the roles played by:
a. Sodium (Na+ symporters for glucose, amino acids, and other nutrients; for HCO3- and
water-soluble vitamins; Na+ antiporters for H+ and also for ammonia (NH3) excreted as
ammonium ion (NH4+)).
b. Electrochemical gradients (promote passive reabsorption of electrolytes such as K+, Ca2+,
Cl-, and Mg2+).
c. Na+-K+-2Cl- symporters (net reabsorption of Na+ and Cl-, but K+ diffuses back into tubular
fluid through leakage channels.)
d. Principle cells (K+ secretion and Na+ reabsorption).
e. Proton pumps (H+ secretion)
f. Cl--HCO3- antiporters (HCO3- reabsorption)
Clinical connection: glucosuria (p. 1011)

Topic 26. Renal Physiology II / Renal Pathology (pp. 1015-1033)

26.6. Tubular Reabsorption and Tubular Secretion (continued)

1. Summarize the roles each of the following hormones plays in the regulation of tubular
reabsorption and tubular secretion (p. 1015, 1016):
Angiotensin II (stimulates Na+-H+ antiporters)
Aldosterone (stimulates principal cell reabsorption of Na+ and Cl-)
Antidiuretic hormone (increases collecting duct reabsorption of water)
Atrial natriuretic peptide (inhibits Na+ reabsorption)
Parathyroid hormone (increases Ca2+reabsorption)
26.7 Production of Dilute and Concentrated Urine
2. Describe renal mechanisms for the dilution (Figure 26-18) or concentration (Figure 26-19)
of urine. Understand the urine-diluting mechanisms of diuretics. (pp. 1018-1022)
26.8 Evaluation of Kidney Function
3. Describe the following clinical procedures used to evaluate kidney function: urinalysis,
blood urea nitrogen, plasma creatinine, and renal plasma clearance. (pp. 1022-1024)
Summarize the characteristics of normal urine, as in Table 26.5 (p. 1022). Be able to identify
the presence of specific urine constituents as either normal or abnormal (compare Table 26.3,
p. 1010 & Table 26.6, p. 1022).
26.9 Urine Transportation, Storage, and Elimination
4. Describe the anatomy, histology, and physiology of each of the following (pp. 1024-1027):
A. Ureters (peristaltic waves, physiological valve, mucosa, transitional epithelium,
muscularis, adventitia)
B. Urinary bladder (trigone, urinary coats, detrusor muscle, internal & external urethral
sphincters, micturition reflex)
C. Urethra (external urethral orifice; components of male urethra: prostatic, membranous,
and spongy)
5. Distinguish between four types of urinary incontinence (p. 1027)

Note: We are not covering 26.10 Waste Management in Other Body Systems, 26.11
Development of the Urinary System
and 26.12 Aging and the Urinary System

6. Describe the following pathological conditions (pp. 1031-1033): renal calculi; urinary tract
infections; glomerular diseases (glomerulonephritis, nephrotic syndrome); renal failure (acute
and chronic); polycystic kidney disease, and urinary bladder cancer.
7. Briefly describe the procedures for cystoscopy and intravenous pyelogram (p. 1033)

Clinical connection: dialysis (p. 1023)