Hatzoglou Chryssi, Zarogiannis Sotirios, Paraskeva Efrosyni,

Face to face lectures, presentation of clinical cases and lab practicals. Attendance of the lab practicals is mandatory. Face to face lecture attendance is not mandatory.

Power point presentations and videos are used for lectures.

The learning process is supported through the e-Class of the Department of Medicine.

The lecture and practical exercise programs, the learning objectives – detailed material, the relevant bibliography, the lecture presentation in the form of pdf files and all information related to the course are posted on the e-class page of the course.

Written exams during the examination period according to the program.

Assessment Language: Greek

The written exams include:

– Μultiple choice questions, true/false, matching, fill the gap, put in the right order or short answer questions. Oral examinations are conducted in special cases, such as students with special learning or motor difficulties.

Assessment criteria are availiable to the students at the beginning of the course and the relevant information is available in the course eclass site.

This course provides the students basic knowledge and background for understanding the physiological function of the human respiratory, immune, urinary, gastrointestinal and cardiovascular systems.

The course material aims at the integrating of the functions of the above systems so that the student acquires a solid background on the positioning and the role of each system in the physiological function of the human body.

Furthermore, the course provides the student with the necessary knowledge of the physiological responses and adaptations of the organism in extreme environments and provides examples of clinical physiology and pathophysiology. Due to the above this course provides the basis on which the student will comprehend the fundamental relationship of physiology and clinical medicine.

Finally, the course aims at having students understand the importance of integrated and in depth knowledge of systems physiology in order to facilitate young physicians of all specialties comprehend the ever growing bulk of new data produced by the fast evolution of health sciences.

Upon successful completion of the course the students will be able to:

• Understand the mechanisms governing the function of the respiratory, immune, urinary, gastrointestinal, and cardiovascular system of the human body with integrative and critical thinking.
• Understand the systems of the human organism and their interaction in order to have a clear and complete view of the physiological function of the human body.
• Understand the recruitment of counter mechanisms in cases of dysfunction of the above systems and the pathological conditions that establish when these mechanisms do not suffice.
• Use the gained knowledge in order to make hypothesis for the disorders and pathological conditions that occur from a change or dismissal of a physiological function of the above systems, analyze the mechanisms and identify the possible targets for the therapy of such conditions.

General Abilities

• Research, analysis and synthesis of data and information.
• Adaptation to new situations
• Decision making
• Autonomous work
• Teamwork
• Promoting free, creative and inductive thinking

Section 1: Respiratory System

• Organization of the respiratory system.
• Atmospheric air composition.
• Respiratory anatomy
• Functions of the respiratory system.
• Other lung physiological roles.
• Units and terminology used in respiratory physiology.

1.2 Respiration Mechanics.

• Lung ventilation.
• Important pressures for ventilation and breathing.
• Thoracic wall and lung parenchyma coupling.
• Pneumothorax.
• Lung compliance.
• Elastic recoil.
• Surface tension.
• Pulmonary surfactant.
• Airway resistances.
• Lung volumes and capacities.
• Alveolar Ventilation.
• Dead space.
• Lung ventilation and perfusion.
• Differences in lung ventilation and perfusion depending on lung anatomical sites.
• Ventilation-perfusion Mismatch.

1.3 Gas exchange.

• Partial pressures of gases.
• Definition of PO₂, and PCO₂, normal values in the alveoli, in arterial and mixed venous blood.
• Factors affecting the rate of gas exchange.
• Evaluation of lung diffusion capacity.
• Pathologic conditions reducing the diffusive capacity of the lungs.

1.4 Gas transport.

• Transport of oxygen in the blood.
• Transport of carbon dioxide in the blood.
• Abnormalities in arterial PO₂.
• Hypoxia.
• Hyperoxia
• Abnormalities in arterial PCO₂.
• Hypercapnia.
• Hypocapnia.

1.5 Acid–Base Balance

• Description of pH and buffers.
• The contribution of respiratory system in acid-base balance maintenance.
• Respiratory acidosis and clinical examples.
• Respiratory alkalosis and clinical examples.

1.6 Control of breathing.

• Respiratory Centers – Neuronal control of breathing.
• Chemical control of breathing.
• Non chemical influences of breathing.
• Respiratory states.
• Control of ventilation during exercise.
• Adaptation to high altitude.

1.7 Respiratory Physiology based on medical cases.

Section 2: Immune System

2.1 Introduction to Immunology. Cells that mediate defense mechanisms. Cytokines.

• Introduction to immunology.
• Definition of immunity.
• Defense
• Lymphoid tissues.
• Functions of lymphoid tissues.
• Types of immune response.
• Cell operators of the immune response.
• Neutrophils.
• Eosinophils
• Basophils
• Mast cells Macrophages.
• Lymphocytes
• Cytokines: production-effects-physiology.
• Chemokines

2.2 Innate immunity.

• Definition and characteristics of the innate immunity.
• Physical and mechanical barriers such as the skin and mucosa. Chemical and microbial barriers.
• Cellular components such as neutrophils, macrophages and natural killer cells.
• Plasma components (complement and acute phase proteins).
• Stages of inflammation.
• Process of phagocytosis.
• Opsonization.
• Interferons

2.3 Antigens – Antibodies.

• Antigens.
• Immunoglobulins – Antibodies.
• Structure and heterogeneity of immunoglobulins.
• Biological effects of immunoglobulins.
• Antibody effects.
• Ιmmunization and polyclonal antibodies.
• Production and use of monoclonal antibodies.

2.4 Adaptive immune response.

• Lymphoid tissues and organs.
• Characteristics and stages of adaptive immune response.
• Stages of adaptive immune response.
• Lymphocyte recognition of antigens.
• Lymphocyte activation.
• Activated lymphocyte action.
• Antigen mediated or humoral immunity.
• Functions of B lymphocytes.
• Immunity mediated by cells or cell immunity.
• T lymphocytes.
• Types of T cellss.
• T-cell receptors.
• Functions of T cells.
• Cytotoxic, or killer, T cells.
• Helper T cells.
• Immune mechanisms against virus-infected cells and cancer cells.
• Regulatory T cells.
• Antigen-presenting cells.
• Antigen presentation.
• Integration of adaptive immune response.
• B and T lymphocytes interactions.
• B versus T Lymphocytes.
• Development of immune tolerance.
• Cancer immune-surveillance.
• Possible causes of autoimmune attack.
• Harmful immune responses.

2.5 Physiology of the immune system based on medical cases.

Section 3: Urinary System (Kidneys)

3.1 Kidneys: Functions and Anatomy.  Micturition.

• Kidney functions.
• Short description of the urinary system.
• Nephron structure.
• Vascular component of the nephron.
• Tubular component of the nephron.
• Comparison of juxtamedullary and cortical nephrons.
• Basic renal processes
• Micturition.

3.2 Kidney processes.

• Glomerular filtration.
• Layers of the glomerular membrane.
• The juxtaglomerular apparatus.
• Forces involved in glomerular filtration.
• Glomerular filtration rate (GFR).
• Mechanisms responsible for regulation of the GFR.
• Tubular re-absorption.
• Transepithelial transport.
• Sodium reabsorption.
• Renin–angiotensin–aldosterone system.
• The natriuretic peptides.
• Glucose reabsorption.
• Tubular maximum.
• Osmotic dieresis – Water dieresis.
• Reabsorption of proteins, peptides and aminoacids.
• Water reabsorption.
• Urea reabsorption.
• Tubular secretion.
• Hydrogen ion secretion.
• Potassium ion secretion.
• Mechanism of potassium
• Regulation of potassium
• Importance of regulating plasma potassium

3.3 Excretion of solutes through urine, and Plasma clearance.

• Definition of plasma clearance from a particular substance.
• The use of clearance for the evaluation of the glomerular filtration rate.
• The use of clearance for the evaluation of kidney plasma flow.
• Filtration fraction.
• Condensation and dilution of urine.
• Osmotic gradient in the renal medulla.
• Countercurrent multiplication in the renal medulla.
• Mechanisms of vasopressin (antidiuretic hormone) action.
• Counter-current exchange in the renal medulla.

3.4 Fluid and electrolyte balance.

• Balance Concept.
• Ionic composition of the main body fluid compartments.
• Fluid Balance.
• Water balance.
• Sodium balance.
• Defense of volume.
• Defense of tonicity.
• Diuretics.
• Therapies of kidney failure.

3.5 Acid-Base Balance.

• Acid-base balance.
• pH homeostasis.
• Systems neutralizing hydrogen ions ion the body.
• Sources of gain and loss of hydrogen ions.
• Kidney mechanisms for acid-base regulation.
• Bicarbonate handling.
• Cellular models of Η⁺
• Normal acid–base balance.
• Regulation of the acid –base balance.
• Disturbances of acid-base balance.
• Respiratory acidocis.
• Respiratory alkalosis.
• Metabolic acidosis.
• Metabolic alkalosis.
• Compensated acid–base abnormalities.
• Uncompensated acid–base abnormalities.

Section 4: Gastrointestinal System.

4.1 General Aspects of Digestion.

• Functions of the organs of the gastrointestinal system.
• Anatomy of components of the digestive systems.
• Basic functions of the gastrointestinal system.
• Structure of the gastrointestinal wall.
• Microvillus structure.
• Enteric neuronal system (ENS).
• Neuronal junctions in the ENS.
• Regulation of digestive function.
• Pathways controlling the functions of the gastrointestinal system.

4.2 Mouth, Pharynx and Esophagus.

• Mouth
• Mastication.
• Functios of saliva
• Functions of saliva.
• Salivary glands and control of salivary secretion.
• Pharynx and esophagus.
• Swallowing.

4.3 Stomach.

• Anatomy of the stomach.
• Functions of the stomach.
• Stomach motility.
• Factors affecting the motility and stomach emptying rate.
• Vomit.
• The stomach mucosa and the gastric glands.
• Parietal cells
• Mechanism of HCl secretion.
• Functions of HCl.
• Gastric secretion.
• Control of gastric fluids secretions.
• Protection of the gastric surface epithelium.

4.4 Pancreatic and BiliarySecretions.

• Secretion of the exocrine pancreas.
• Pancreatic enzymes.
• Aqueous alkaline solution.
• Regulation of pancreatic secretion.
• Prevention of pancreatic autodigestion.
• Liver functions.
• Liver perfusion.
• Liver organization.
• Production of bile.
• Secretion of bile.
• Enterohepatic circulation of bile salts.
• Function of bile salts.

4.5 Small intestine.

• Small intestine motility.
• Segmentation and mixing.
• Migratory motility complex.
• The ileocecal juncture.
• The small intestine’s surface area.
• The brush-border membrane enzymes.
• Digestion and absorption of carbohydrates.
• Digestion and absorption of proteins, peptides and aminoacids.
• Digestion and absorption of lipids.
• Absorption of vitamins and metals.
• Synopsis of fluids and electrolytes transport in the gut.
• Regulation of gut ion transport.
• Mucosal regeneration of the small intestine.
• Diarrhea.

4.6 Large intestine (Colon).

• Anatomy of the large intestine.
• Functions of the colon.
• Colon motility.
• Defecation reflex.
• Contipation.
• The colon’s beneficial bacteria.
  • Overview of the gastrointestinal system hormones.
• Gastin.
• Secretin.
• Cholecystokinin
• Glucose-dependent insulinotropic peptide (GIP).

Section 5: Cardiovascular System.

5.1 Structure of the cardiac muscle.

• Components of the cardiovascular system.
• The heart as a pump.
• Heart valves.
• The heart walls.
• Cardiac muscle fibers.
• Pericardial sac.

5.2 Electrical activity of the heart.

• Cardiac muscle cells.
• Contractile cells.
• Autorhythmic cells.
• Cardiac pacemaker activity.
• Pacemaker potentials and action potentials.
• Normal pacemaker activity.
• Abnormal pacemaker activity.
• Cardiac excitation spreading.
• Temporal correlation between action potential and subsequent contraction-relaxation of a myocardial cell.
• Coupling of excitation-contraction of the cardiac muscle and the role of calcium ions.
• Refractory period in cardiac muscle.

5.4 Electrocardiography (ECG).

• Electrocardiogram leads.
• Association of electrocardiogram waveforms with specific events of the cardiac cycle.
• Abnormalities in heart rhythm, heart rate and myocardial defects.

5.4 Mechanical events of the cardiac cycle.

• Cardiac cycle.
• Systolic stages.
• Diastole.
• Heart sounds.
• Heart murmurs.

5.5 Cardiac output and its regulation.

• Cardiac output.
• Definition of cardiac output.
• Determinants of cardiac output.
• Regulation of heart rate.
• Regulation of stroke volume.
• Frank-Starling law.
• Compliance.
• Heart failure.

5.6 Systemic circulation. Microcirculation and lymphatic system.

• Nourishing the Heart Muscle.
• Coronary circulation.
• Coronary artery disease.
• Heart attack.

-Vascular spasm of the coronary arteries.

-Atherosclerosis.

-Thromboembolism.

• Pressure, flow and resistancies.
• Arteries.

ü  Features of Arteries.

ü  Arterial blood pressure.

• Mean arterial pressure.
• Measurement of blood pressure.
• Arterioles.
• Features of Arterioles.
• Local control system.
• Exogenous control system.
• Capillaries.
• Features of Capillaries
• Anatomy of capillary network.
• Blood flow velocity in capillaries.
• The role of precapillary sphincters.
• Diffusion across the capillary wall.
• Factors that enhance diffusion across capillaries.
• Bulk flow across the capillary wall.
• Forces influencing bulk flow.
• Veins
• Features of the veins.

ü  Factors defining venous pressure.

ü  Definition of the venous return.

• Factors that enhance venous return.

·   Anatomy and importance of lymphatic system.

5.7 Blood Pressure.

• Blood pressure.
• Determinants of mean arterial pressure.
• Short term regulatory mechanisms.
• Baroreceptors reflexes.
• Other reflexes and responces.
• Long term regulatory mechanisms.
• Hypertension.
• Circulatory shock.

Recap

Physiology based on medical cases.

Content of Laboratory Practicals

Practical 1: Spirometry- Peak flow measurement- Pulse oxymetry- eCO measurement.

• Short description of every test via videos.
• Spirometry, peak flow measurement, pulse oxymetry and exhaled CO measurements in the lab.
• Interpretation of normal and pathological findings of the above tests.

Practical 2: Physiology of urinary system based on medical cases.

• Clinical case discussion.

Practical 3: Physiology of gastrointestinal system based on medical cases.

• Clinical case discussion.

Practical 4: Arterial pressure – Cardiac auscultation.

• Short description of the cardiac auscultation and arterial pressure measurement.
• Video.
• Cardiac auscultation in the lab.
• Arterial pressure measurement in the lab, and registration of systolic, diastolic, mean arterial pressure, and pulse pressure.

Practical 5: Electrocardiography (ECG).

• Short description of 12 lead Electrocardiogram.
• Recording of ECG in the laboratory.
• Measurement of heart rate.
• Waveforms of atrial and ventricular depolarization.
• Segment counting in the electrical conducting system of the heart.
• Normal and pathologic heart rate findings.

Proposed Books

1. Carrie E. Mahoney (Editor English Edition) Human Physiology

     Copyright © 2023 Edi.Ermes s.r.l. – Milan (Italy)

     ISBN 978-88-7051-653-1

2. Guyton and Hall Textbook of Medical Physiology, 14th Edition, ELSEVIER 2020

Other Books in Greek

• Ganong’s Medical Physiology

      Editor: Barett K.

      Εκδόσεις: BROKEN HILL PUBLISHERS LTD

• Vander’s Human Physiology – The mechanisms of body,

Editors: Widmaier E., Raff H. Strang K.

Εκδόσεις: BROKEN HILL PUBLISHERS LTD