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SUMMARY 1.3 regulation integration
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here you will find all the cases, very extensive and well explained - some lectures, some articles and some skills (ABCDE)
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Blok 1.3: Regulatie en IntegratieResources:
● Clinical Key
● Guyton
● Boron Boulpaep
● Silverthorn
● Marieb
Contacts:
● Planning Piet Leroy, Jos Broers, Frans van Nieuwenhoven, Ben Janssen,
● Speakers: Victoria van Salmuth (shiratifoodprogram@gmail.com), Biserka Pop Stefanija
,Openingscollege: Homeostase.
Er zijn regelsystemen om de omstandigheden in het interne
milieu constant te houden (homeostase). De pH, osmotische
waarde lichaamsvloeistof, suikergehalte bloed,
zuurstofgehalte, lichaamstemperatuur. Een regelsysteem is
negatieve feedback: Een sensor, receptor, is zintuig dat
veranderingen in interne milieu waarneemt en deze doorgeeft
aan een controlecentrum, vaak hypothalamus. Vervolgens kan
het controlecentrum de effectoren beïnvloeden; de organen
indien er een bepaalde waarde (setpoint) overgeschreven
word.
Het effect word gemeten door de sensor, zodra de situatie
weer normaal word, oftewel onder setpoint worden de
effectoren uitgezet interne milieu binnen grenzen.
Temperatuur sensor ligt in hypothalamus: controlemechanismen en sensor. Zo word de
concentratie CO2 gemeten in aorta en halsslagader; sensoren.
Door middel van het hormoonstelsel, endocrien, staan de effectoren, sensoren,
controlemechanismen met zenuwstelsel in verbinding. Hypothalamus en verlengde merg is
belangrijk voor de homeostase, en de hypothalamus is in contact met hypofyse. Vanuit
verlengde merg word hartslag, ademhaling en spijsvertering geregeld: vegatieve
zenuwstelsel, orthosympathisch en versnelt hartslag, ademhaling en vertraagd
spijsvertering. Hormoon adrenaline uit het merg van bijnier heeft zelfde effect.
Cellen zitten in een constante omgeving. Milieu is ook heel belangrijk; de cellen moeten
pogen om bij een veranderd milieu toch een zelfde werking te houden (homeostase).
● Claude Bernard is de ontdekker van het milieu interieur.
● Walter Cannon definieert homeostase en wat fight and flight mogelijk maakt in het
lichaam.
1. Een variabele veranderd Te weinig water
2. word gemeten door een sensor
3. naar integrator
4. effector
5. oplossing de variabele veranderd weer; water level stabiel
Het is belangrijk om nu de kennis te integreren en bijvoorbeeld gebruik te maken van feed
back loops bij iets als het RAAS systeem en andere biologische processen dit blok.
● Casus 1: Homeostase – stress – HPA Axis / Biologische klok
● Casus 2: Algemene nier functie, blaas mictie, glomerulus
● Casus 3: Renale Tubulus functie
,Expert Knowledge (4 artikelen)
Zoeken artikelen op PUBMED en zoekproces bespreken met de groep. Tutor heeft
zoektermen en artikel geselecteerd; deze mag je zelf gaan bestuderen. De eindtoets bevat
vragen hieruit.
Effect van biological clock op:
● Casus 1: melatonin
● Casus 2: hypertensive-medicatie
● Casus 3: kidney function
● Casus 5: Cell death
Workshop ethiek:
gekoppeld aan academische schrijfopdracht: arts-patiënt en levenseinde. Symposium:
meaning of Death; juridisch, cultureel, religieus en ethisch.
Academische schrijfopdracht, in duo’s:
Artikel: E. Emanuel, vanaf mijn 75ste jaar zeg ik nee tegen antibiotica
Simulatiepatiënt: Casus 6
Op donderdag 23 januari 2020 is voorbespreking; anamnese.
Tussentoets:
Formatief: Do 16 jan 19:00 tot Zo 19 jan 23:59, via pscribe. Feedback in interactieve sessie.
, Case 1: biological clock
Difficult words:
-
Main focus:
o HPA Axis:
Hypothalamus: controller
Pituary gland: initial effector (hypophyses)
Adrenal gland second effector: it secrets hormones into the body: the more hormones get
secreted the bigger the effect is (bijnier)
o Releasing hormones: CRH, produced in hypothalamus: now the HPA will react and the
pituitary gland will reply with ACTH, now the adrenal gland gets positively affected and
produces cortisol. Now negative feedback to hypothalamus, less CRH gets produced.
o Water absorption and excretion, effected by cortisol
o Endocrine organs
o Fight or flight system: sympathic nerves
- Positive and negative feedback : in all systems
- Biological clock: how is it effected by stress?
- Just a general idea on how stress effects your entire body and biological system.
- Factors and effects of water, heat, and dehydration
- Jet lag?? homeostasis?
Brainstorm:
● The body follows the rhythm of the day: many systems of the body are dependent on this
biological clock, a circadian rhythm (24 hours) + hormones (menstruation: monthly)
● Northern Europe: really short day: people getting depressed because of the lack of light
● Melatonin is effected by circadian rhythm and light: biological clock relationship.
● Cortisol is very important: in the morning this level is high, and it decreases during the
day. Also testosterone (peaks in morning)
● ADH: anti-diuretic-hormone on a nephron level: water retention. Cortisol makes the water
retention go up.
● Growth Hormone and even the cell cycle and cell division: their daily rhythm; these divide
better at night
● Pituary gland produces an hormone that has a negative effect on a different thing (?).
● Clock genes make you develop more hormones. The circle is also 24 hours and it starts
at cell level, each having a master clock. You have clock-dependent prescription.
● Cortical amines: adrenal glands, nor epifrine will go to blood steam and so the muscles
receive more blood. Organs thar are not needed are getting inhibited. These components
always bind to the surface of the cell and receptor. The system itself stays outside it.
● Cortisol is a steroid hormone; a fatty hormone so it can through the cell membrane and
go inside by diffusion so it’s a passive process. It effects genes and proteins.: so it is
slower in general then nor eprine or adrenaline. Cortisol also breaks down protein in
muscles and compensates for energy loss (quickly)
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