Balanced Diet

Energy Balance o Energy is obtained from food Main energy from carbohydrates (glucose) and fats Proteins are used for growth and repair first Excess proteins is converted to energy o Out of balance More energy/food than required obesity Less energy/food than required starvation o Types of carbohydrates Intrinsic sugars: found within cells (fruits) Extrinsic sugars: sugars that have been added to food (processed food) Milk sugars: found in milk products Basal Metabolic Rate (BMR) o Energy needed at rest (not when asleep!) for routine tasks of cells (excrete waste) o Factors that influence BMR Age Young > Old Growth requires more energy children, pregnant women (fetus) Young and active people have more muscles than older people Sex Male > Female Women have more adipose than muscle tissue Muscles (work out) require more energy than fat cells (storage) Body size Tall and thin > short and obese

Tall and thin people have a large surface area but small volume Loose heat quicker Need more energy to maintain body temp High body mass > Low body mass High body mass more cells that require energy

Starvation o No carbohydrates and fats are available in the diet o Body starts to break down its own proteins (muscles)

Function of Fibres

Polysaccharides (cellulose) that cannot be broken down by enzymes in the gut o Reduce absorption of carbohydrates o Reduce hunger Prevent constipation (need plenty of water) o Speed up passage of food through intestine o Less time for toxins to accumulate o This reduces risk for colon cancer

Water

Makes up 65% of our body weight/body mass Requirements depend on o Intake of water by food o Body size o Physical activity o Environment (hot? cold?)

In normal conditions, 2L of water per day is recommended o Dehydration causes reactions inside cells to slow down o Overhydration causes dangerously low sodium levels [background reading] How is water lost? o Breathing o Sweating o Excretions (urine, faeces) o Diuretics (alcohol, caffeine), which increase the amount of water in the urine

Carbohydrates

Starch and sugar o Provide 80% of total chemical P.E. o Breast-fed infants obtain 40% of their chemical P.E. from lactose Non-starch polysaccharides (e.g. glycogen) o Control appetite o Prevent appendicitis, colon cancer, haemorrhoids, constipation Store and transport energy Glucose is the main energy source in the brain

Lipids

Source of chemical P.E. (energy reserve) Phospholipids are essential for plasma membranes Essential fatty acids are precursors of other important substances Needed to absorb fat-soluble vitamins Maintain body temperature

Proteins

Required for growth and repair in cells and tissues (children require more!) Carrier (change shape for different molecules) for watersoluble molecules such as glucose Ion channels (sodium and chloride ions) Pumps use energy to move water-soluble molecules and ions Enzymes, which speed up chemical reactions at the edge of the membrane Receptors enable hormones and nerve transmitters to bind to specific cells Recognition sites, which identify a cell as being of a particular type Adhesion molecules for holding cells to extracellular matrix

Vitamins

Often interact with enzymes to speed up metabolic reactions Most are essential (must be absorbed from food) Only vitamin D (skin) and vitamin K (gut bacteria) are non-essential (produced by body) Fat soluble o Vitamin A: vision, growth, reproduction o Vitamin D: regulates calcium levels, bone formation o Vitamin E: antioxidant (prevent cancer, Alzheimer) o Vitamin K: blood clotting Water soluble o Vitamin C: antioxidant, wound healing, synthesis of adrenaline, bone formation

Vitamin B12 and folic acid: cell division (low levels cause anaemia) Supplements o Vitamins A and D (fat soluble) Cannot be excreted from body Only small amounts are needed, rest stored within liver Excessive intake from supplements can cause liver damage o Vitamin C (and other water soluble vitamins) Not stored - regular intake required for good health Excess excreted in urine o In the UK, supplements are only useful for Pregnant women (growth) Elderly (less efficient absorption, less appetite)
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Mineral Ions

Sodium: water balance (maintain osmotic pressure) Chloride: maintain osmotic pressure, required for acid production in stomach Potassium: abnormal levels cause abnormal heart rhythms Calcium: bones and teeth, regulation of heartbeat, muscle contraction, blood clotting, nerve and brain function (important for synapses) Phosphate: nucleic acids, ATP, phospholipids, bones and teeth Iron: haemoglobin (low levels cause anaemia) and myoglobin formation

Healthy diet

EAT fruit and vegetables o 5 portions of fruit each day o Contain fibres (prevent constipation) o Contain vitamins (antioxidants) MORE starch than sugar o Starch (pasta, rice, brown bread) releases glucose more slowly o Food with a high GI (food rich in sugar) is linked to obesity RESTRICT salt and fats o Heart disease is caused by a diet High in fat - increases cholesterol High in saturated fats High in salt - increases BP in hypertension (not in people with normal blood pressure) o Replace saturated with polyunsaturated fats Omega 3 fatty acids (oily fish) protect from heart disease Alcohol is not a risk factor for coronary heart disease (CHD)! o In fact, one glass wine per day reduces the risk of CHD

Gut Bacteria (Intestinal Flora)

Healthy gut flora o Harmless gut bacteria (symbiotic relationship) Compete with harmful gut bacteria and reduce their disease-causing ability Produce most of vitamin K Strengthen the immune system o Babies are born without a gut flora Pick up bacteria from surroundings

Breastfeeding helps to establish a healthy gut flora Balance between harmless and harmful gut bacteria o Overgrowth of harmful bacteria or loss of harmless bacteria disturbs this balance o Can cause malabsorption and abdominal discomfort

Vitamin K

Used by E. coli for their respiration Released into and absorbed from the gut after E. coli die Deficiency is common in newborn (sterile gut flora!) haemorrhagic disease of the newborn o Impaired blood clotting o Babies bleed easily from Mucous membranes, such as nose Intestines Cuts in the skin o Treated with vitamin K (by mouth or injection) Formula milk contains vitamin K o Vitamin K deficiency is more likely in babies who are breastfed o Takes time for E. coli to settle down within the gut

Probiotic Drinks

Contain "good" bacteria o Help to restore the balance of a healthy gut flora o Modify the immune system and reduce hay fever (1) Only useful with an impaired gut flora caused by o Unbalanced diet o Inflammatory bowel disease (IBD) o Some antibiotics, which eradicate (kill) bacteria in the gut

Glycaemic Index (GI)

Effect of 50g carbohydrates on blood glucose levels o Thus, how much and how quickly glucose is released from food o 50g of glucose GI = 100 Low GI (<55) - slow release of glucose/energy from food High GI (>70) o Factors that affect GI Branching of starch (more bonds takes longer to digest lower GI) Fibres and vinegar (lowers pH) slow down absorption of starch Low GI food (fruit, vegetables, pasta, rice) o Complex/intrinsic sugars o Contain large carbohydrates (starch) Made up of many bonds that need to be broken Blood glucose levels rise and fall slowly Glucose is converted to glycogen (storage compound) in the liver Keeps blood glucose levels constant o Prevents disease and improves control of blood glucose in diabetics High GI food (Lucozade, white bread, croissants, candy) o Simple/extrinsic sugars o Contain small carbohydrates (glucose) Easy to digest and quickly absorbed from the gut Rapid and prolonged rise of blood glucose levels This releases large amounts of insulin from the pancreas

Not enough time to convert all glucose to glycogen Glucose is stored as fat instead (obesity) High glucose levels can damage arteries (atherosclerosis) Sharp rise of insulin may cause sudden drop of blood glucose Stimulates hunger (obesity) Tiredness Loss of concentration

Glycaemic Load (GL)

Better indicator than GI alone o Small amount of high GI food has same effect as high amount of low GI food o Takes into account complexity (GI) and amount of sugar in food GL = grams of carbohydrates x [GI / 100] o High GL (>20) o Low GL (<10)

Diet and Disease Processed Foods

Raw food (bread, cereals, biscuits, cakes, pastries) is altered to improve its taste Account for 75% of childrens salt intake Rich in salt, simple sugars and fat (obesity) Food labels identify unhealthy food o Traffic light system Red = high amount Yellow = medium amount Green = low amount

Guideline daily amounts (GDAs) system Labels show amounts in one serving Those are compared to guideline daily amounts

Food Additives

Given an E number when it has passed safety tests Make food o Taste nicer (flavour enhancers, such as glutamate) o Look nicer (colourings, such as caramel) o Last longer (antioxidants, such as vitamin C) o Prevent bacterial growth (preservatives, such as sulphur dioxide) Some people are intolerant to glutamate and, hence, most food products!

Obesity

BMI > 30 // BMI = body mass (kg) / height (m) Eat more energy/food than required o Lack of exercise o Unhealthy diet Risk factor for type 2 diabetes Obesity and diabetes strong risk factor for heart disease, stroke, hypertension Risk for cancer o Obese patients suffer from more inflammation than the normal population o Inflammation increases cell turnover o Higher chance for mutations that can cause cancer Risk for fatty liver disease o Fat may deposit within the liver - can be reversible! o In 1%, this may progress to inflammation of the liver (risk for liver cancer!)

Can cause osteoarthritis and rheumatoid arthritis o Weight damages joints and bones over time

Type 2 Diabetes

Failure of blood glucose regulation Cells have become insensitive to insulin Prolonged, high blood glucose levels causes o Heart disease o Blindness o Nerve damage o Foot ulcers

Isotonic Sports Drinks (Lucozade)

Isotonic means same water potential as blood plasma Heavy exercise for prolonged time o Higher sweat production loss of inorganic ions and water o Higher rate of respiration loss of glucose o Body reserves are lost and performance decreases Isotonic drinks replenish ions (electrolytes), water and glucose (energy) o Increase performance o Prevent dehydration Drinks are beneficial in moderate amounts after heavy exercise Contain high levels of glucose - dangerous in diabetes! Drinking more water OR sports drinks than fluid lost during heavy exercise o Can cause dangerously low sodium levels! (2) o Water starts to move into cells o Brain cells swell but cannot expand due to bony skull

This causes vomiting, headache, confusion, coma, or even death

Large Molecules

Monomer (-OH) + monomer (-H) polymer + H2O(l) Condensation: monomers join to form polymers o Amino acids join to form a dipeptide (protein) Two amino acids release -H and -OH groups (H2O) Peptide bond forms between the alpha-carbon and nitrogen o Monosaccharides join to form disaccharides Glycosidic bond forms between both monomers Hydrolysis: break down of a polymer o Reverse of the condensation reaction o This is the process of digestion

Carbohydrates

Organic molecules which contain C, H and O Bind together in the ratio Cx(H2O)y Monosaccharides single sugar (monomer) o Ribose found in RNA and DNA o Deoxyribose part of nucleic acids o Glucose is the main energy source in brain o Fructose is found in sweet-tasting fruits Disaccharides two sugar residues (2 monomers) o Sucrose (glucose + fructose) transport carbohydrates in plants o Maltose (glucose + glucose) formed from digestion of starch o Lactose (glucose + galactose) found in milk Polysaccharides many sugar residues (polymer)

Starch (alpha-glucose) main storage of carbohydrates in plants Glycogen (alpha-glucose) main storage of carbohydrates in humans Cellulose (beta-glucose) component of plant cell wall, important for digestion

Starch

Consists of amylopectin and amylose (both are made of glucose) o Amylopectin is branched via 1,6-glycosidic bonds o Amylose forms a stiff helical structure via 1,4glycosidic bonds o Both are compact molecules starch can be stored in small space The ends are easily broken down to glucose for respiration Does not affect water potential as it is insoluble Readily hydrolysed by the enzyme amylase found in the gut and saliva Found in corn (maize), wheat, potato, rice

Glycogen

Found in skeletal muscle and liver Insoluble, branched polymer, made of -glucose linked via glycosidic bonds Glycogen is broken down to glucose by glycogenolysis (glycogen phosphorylase) Major site of daily glucose consumption (75%) is the brain via aerobic pathways Most of the remainder is utilized by erythrocytes, skeletal muscle, and heart muscle

Glucose is obtained from diets or from amino acids and lactate via gluconeogenesis Storage of glycogen in liver are considered to be main buffer of blood glucose levels

Cellulose

Polysaccharide consisting of long beta-glucose chains Linked together by hydrogen bonds to form microfibrils Humans have no enzymes to break down beta-glucose

Lipids

Easily dissolved in organic solvents but not in water Triglycerides (fats and oils) o Also called triacylglycerides (TAG) o Consists of 3 fatty acids linked by ester bonds to glycerol Require 3 condensation reactions (but are not polymers!) Glycerol contains 3 -OH groups One fatty acid contains a -COOH group o Excess energy available from food is stored as TAG o Can be broken down to yield energy when needed o Contain twice as many energy stored per unit of weight as carbohydrates Saturated fatty acids o -COOH group without double bonds in the carbohydrate chain o May cause blockage of arteries which can lead to strokes and heart attacks o High melting point / solid at room temperature (fats) / typical animal fats Unsaturated fatty acids

-COOH group with double bonds in the carbohydrate chain o Low melting point / liquid at room temperature (oils) o Found in plants Phospholipids o Found in cell membrane o Formed by replacing one fatty acids in a triglyceride with a phosphate group o Phosphate is polar / hydrophilic / does mix with H2O o Fatty acid tails remain non-polar / hydrophobic / insoluble, does not mix with H2O
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Proteins

Proteins are made up by different combinations of 20 amino acids o Common structure -COOH group -NH2 group o Amino acids differ in their R-group Tertiary structure o Complex globular 3D shape o Folding and twisting of polypeptides (H-bond, ionic bonds, disulphide bridges) o Polypeptides contain many peptide bonds Same amino acid sequence ALWAYS same shape Bonds found in proteins o Hydrogen bonds Between R-groups Easily broken, but present in larger numbers The more bonds, the stronger the structure o Ionic bonds

Between -COOH and -NH2 groups o Disulphide bridges Between two sulphur-containing cysteine side chains Strong bonds found in skin and hair Denaturation o Destruction of tertiary structure, can be done by heat o Protein structure is lost and cannot reform dysfunctional Background Reading: Structure of Proteins http://www.chemguide.co.uk/organicprops/aminoacids/pr oteinstruct.html

Digestion

Large molecules (starch, proteins, TAG) are too big and insoluble to be absorbed o Polymers have to be broken down into monomers o With help of hydrolytic enzymes - reaction requires H2O o Note: TAGs are not polymers but also need to be broken down Different enzymes break down different food o Work best at body temperature (37) o Work in different conditions at different pH (stomach is acidic, intestine is alkaline) Hydrolysis o Proteins amino acids Essential amino acids: cannot be synthesised and must be present in diet Non-essential amino acids: synthesised from essential amino acids by transamination in the liver

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TAG glycerol and fatty acids Polysaccharides monosaccharides

Chromatography

Separates a mixture to identify its components Stationary phase: paper (cellulose) Mobile phase: liquid solvent Method o Pencil is used to draw a horizontal line on paper to mark the origin o Small drop of solution is placed on the pencil line to form a spot o Paper is fastened with a drawing pin to a bung o This is placed in a boiling tube with some amount of solvent inside o Spot needs to be suspended above the level of solvent! Analysis o Rf = (distance moved by substance) / (distance moved by solvent)

What are enzymes?

All enzymes are globular proteins spherical in shape Control biochemical reactions in cells They have the suffix "-ase" Intracellular enzymes are found inside the cell Extracellular enzymes act outside the cell (e.g. digestive enzymes) Enzymes are catalysts speed up chemical reactions o Reduce activation energy required to start a reaction between molecules o Substrates (reactants) are converted into products

Reaction may not take place in absence of enzymes (each enzyme has a specific catalytic action) o Enzymes catalyse a reaction at max. rate at an optimum state Lock and key theory o Only one substrate (key) can fit into the enzyme's active site (lock) o Both structures have a unique shape Induced fit theory o Substrate binds to the enzyme's active site The shape of the active site changes and moves the substrate closer to the enzyme Amino acids are moulded into a precise form Enzyme wraps around substrate to distort it o This lowers the activation energy o An enzyme-substrate complex forms fast reaction o E + S ES P + E Enzyme is not used up in the reaction (unlike substrates)
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Enzyme Activity

Changes in pH o Affect attraction between substrate and enzyme o Ionic bonds can break and change shape enzyme is denatured o Charges on amino acids can change ES complex cannot form o Optimum pH (enzymes work best) pH 7 for intracellular enzymes Acidic range (pH 1-6) in the stomach for digestive enzymes (pepsin) Alkaline range (pH 8-14) in oral cavities (amylase)

pH measures the conc. of hydrogen ions higher conc. will give a lower pH Enzyme conc o Proportional to rate of reaction, provided other conditions are constant o Straight line Substrate conc. o Proportional to rate of reaction until there are more substrates than enzymes present o Rate of reaction increases Substrate binds to active site, but more enzymes are available Rate increases if more substrate is added o Eventually, curve becomes constant (no increased rate) Substrates occupy all active sites (all enzymes) Adding more substrate won't yield more product, as no more active sites are available Increased Temperature o Increases speed of molecular movement chances of molecular collisions more ES complexes o At 0-42C rate of reaction is proportional to temp o Enzymes have optimum temp. for their action (usually 37C in humans) o Above 42C, enzyme is denatured due to heavy vibration that breaks -H bonds o Shape is changed active site can't be used anymore Decreased Temperature o Enzymes become less and less active, due to reductions in speed of molecular movement o Below freezing point Inactivated, not denatured Regain their function when returning to normal temperature
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Thermophilic: heat-loving Hyperthermophilic: organisms are not able to grow below +70C Psychrophiles: cold-loving

Enzymes - Heroes and Villains Analytical reagents

Made up of 2 enzymes (glucose oxidase and peroxidise) and a colourless hydrogen-donor fixed on a strip o The strip is dipped into a test solution (urine) o Colour develops which indicates that glucose is present o This method is used by diabetics to monitor their blood glucose levels o In healthy people, the urine contains NO glucose Glucose oxidase o Highly sensitive to low conc. of glucose o Highly specific because it only reacts with one specific substrate (glucose) o Catalyses the conversion of glucose to hydrogen peroxide (H2O2) Peroxidase o Catalyzes reaction between colourless hydrogendonor molecule and H2O2 o A coloured molecule is formed

Alpha1-antitrypsin

Function o White blood cells (neutrophils) in the lung help to prevent infections o They also release elastase and protease (trypsin)

Those enzymes break down/digest ct. and proteins inside the lungs and damage it o NB: Trypsin is also found in the digestive system and digests food! o The anti-protease alpha1-antitrypsin protects the lungs from elastase and protease Alpha1-antitrypsin deficiency o Genetic disease that causes emphysema o Trypsin is no longer inhibited and damages the lungs o Walls of alveoli are damaged and surface area for gas exchange is reduced o Patients can be treated by infusing alpha1antitrypsin Smoking o Increases the number of neutrophils in the lungs (more trypsin is secreted into the lungs) o ALSO inactivates alpha1-antitrypsin o This creates an imbalance between proteases (trypsin) and anti-proteases (1-antitrypsin) o Same lung damage as in 1-antitrypsin deficiency but much slower
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Lung structure

Nose Air is filtered in nostrils with small hairs o Air is moistened and warmed by nasal cavities o Mucus traps foreign particles while cilia propels particles towards the throat Air passes into the pharynx larynx trachea o The epiglottis is found within the larynx o Breathing: epiglottis projects upwards larynx is open
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Swallowing: larynx pulled up / epiglottis flaps back and blocks larynx / prevents food from entering airway Trachea o Contains C-shaped cartilage rings / prevents collapse of tube o Divides into 2 tubes with smaller diameter called bronchi o Bronchus is supported with ciliated epithelia to prevent microorganisms o Right bronchus is bigger than the left one common site for inhaled foreign bodies Bronchi further divide into bronchioles o Their diameter can be controlled by smooth muscles o Form alveoli (100m in diameter)
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Ficks law

Rate of diffusion is proportional to (surface area x conc. difference) / distance Applies to exchange of food, waste, gases, and heat with surroundings Large organisms o Have a small surface area : volume ratio o Decreases the rate of diffusion o Large animals loose less heat than small animals o Don't require a high metabolism to maintain body temperature o Feed only once Small organisms o Lose heat very readily o Need a high metabolism to maintain body temp o Must feed continuously More detail in Unit 2 Section 3.2.4

[exam] Efficient gas exchange requires: o Large surface area o Large concentration gradient (low O2 on one side, high O2 on the other site of the membrane) o Short diffusion pathway (thickness of membrane molecules must travel to diffuse across)

Alveolar Gas Exchange

Greater partial pressure of O2 in alveolar air / more O2 dissolves in blood (Henry's Law) Two types of alveoli cells Type I cells o Composed of endothelium - layer of two thin cells o This allows diffusion of gases (short diffusion pathway) down their conc. gradients o O2diffuses from air to blood; CO2diffuses from blood to air Type II cells o Secrete surfactant that keep alveoli constantly moist o Allows oxygen to dissolveand to diffuse through the cells into the blood o In the blood, it is taken up by haemoglobin Alveoli contain phagocytes to kill bacteria that have not been trapped by mucus Ventilation o Flow of air in and out of alveoli o Maintains large concentration gradient

Fluid-Mosaic Model

Membranes consist of a phospholipid bilayer studded with proteins, polysaccharides, lipids The lipid bilayer is semipermeable - H2O and some small, uncharged, molecules (O2, CO2) can pass through

Phospholipids have two parts o "Head": hydrophilic attracts and mixes with H2O o Two "fatty acid tails": hydrophobic

Passive Transport Diffusion

Uses energy from moving particles (kinetic energy) Substances move down their conc. gradient until the conc. are in equilibrium Fick's law rate of diffusion across an exchange surfaces (e.g. membrane, epithelium) depends on o Surface area across within diffusion occurs (larger) o Thickness of surface (thinner) o Difference in conc. gradient (larger) o (surface area * difference in conc.) / thickness of surface Microvilli o Extensions of the plasma membrane o They increase the surface area of the membrane o Accelerate the rate of diffusion Temperature increases rate of diffusion due to increasing K.E. (kinetic energy)

Facilitated Diffusion

Transmembrane proteins form a water-filled ion channel o Allows the passage of ions (Ca2+, Na+, Cl-) down their conc. Gradient o NB: this is a passive process no ATP required o Some channels use a gate to regulate the flow of ions o Selective permeability not all molecules can pass through selective channels

Transport mechanism o Carrier protein binds to substrate (specific molecule) o Molecule changes shape o Release of the diffusing molecule (product) at the other side of the membrane Example o If you want to move a muscle, a nerve impulse is sent to this muscle o The nerve impulse triggers the release of a neurotransmitter o Neurotransmitter binds to a specific transmembrane protein o The protein opens channels that allow the passage of Na+ across the membrane o In this specific case, this causes muscle contraction o These Na+ channels can also be opened by a change in voltage

Osmosis

Special term used for the diffusion of water through a differentially permeable cell membrane Water is polar and able to pass through the lipid bilayer Transmembrane proteins that form hydrophilic channels accelerate osmosis, but water is still able to get through membrane without them Osmosis generates pressure called osmotic pressure o Water moves down its conc. gradient o When pressure is equal on both sites net flow ceases (equilibrium) o The pressure is said to be hydrostatic (waterstopping)

Water Potential

Measurement of ability or tendency of water molecules to move Water potential of distilled water is 0, other solutions have a negative water potential Hypotonic: solution with a lower conc. of solute / gains water by osmosis o Solution is more dilute o Cells placed in a solution which is hypotonic will grow as water moves in o Red blood cells will swell and burst if it is in a hypotonic solution o Plant cells are unable to burst due to their strong cellulose wall Hypertonic: solution with a higher conc. of solutes / loses water by osmosis o Cells will shrink in hypertonic solutions (eg red blood cells) Isotonic: solutions being compared have equal conc. of solutes o Cells which are in an isotonic solution will not change their shape o The extracellular fluid of the body is an isotonic solution Molecules collide with membrane / creates pressure, water potential More free water molecules, greater water potential, less negative Solute molecules attract water molecules which form a "shell" around them o water molecules can no longer move freely o less "free water" which lowers water potential, more negative

Active Transport

Movement of solute against the conc. gradient, from low to high conc. Involves materials which will not move directly through the bilayer Molecules bind to specific carrier proteins / intrinsic proteins Involves ATP by cells (mitochondria) / respiration o Direct active transport - transporters use hydrolysis to drive active transport o Indirect active transport - transporters use energy already stored in gradient of a directly-pumped ion Bilayer protein transports a solute molecule by undergoing a change in shape (induced fit) Occurs in ion uptake by a plant root; glucose uptake by gut cells

Ribosomes

20-30nm in size Small organelles often attached to the ER but also found in the cytoplasm Large (protein) and small (rRNA) subunits form the functional ribosome o Subunits bind with mRNA in the cytoplasm o This starts translation of mRNA for protein synthesise (assembly of amino acids into proteins) Free ribosomes make proteins used in the cytoplasm. Responsible for proteins that o go into solution in cytoplasm or o form important cytoplasmic, structural elements

Ribosomal ribonucleic acid (rRNA) are made in nucleus of cell

Endoplasmic Reticulum (ER)

Rough ER o Have ribosomes attached to the cytosolic side of their membrane o Found in cells that are making proteins for export (enzymes, hormones, structural proteins, antibodies) o Thus, involved in protein synthesise o Modifies proteins by the addition of carbohydrates, removal of signal sequences o Phospholipid synthesis and assembly of polypeptides Smooth ER o Have no ribosomes attached and often appear more tubular than the rough ER o Necessary for steroid synthesis, metabolism and detoxification, lipid synthesis o Numerous in the liver

Golgi Apparatus

Stack of flattened sacs surrounded by membrane Receives protein-filled vesicles from the rough ER (fuse with Golgi membrane) Uses enzymes to modify these proteins (e.g. add a sugar chain, making glycoprotein) Adds directions for destination of protein package vesicles that leave Golgi apparatus move to different locations in cell or proceed to plasma membrane for secretion Involved in processing, packaging, and secretion Other vesicles that leave Golgi apparatus are lysosomes

Endocytosis and Exocytosis

Substances are transported across plasma membrane in bulk via small vesicles Endocytosis o Part of the plasma membrane sinks into the cell o Forms a vesicle with substances from outside o Seals back onto the plasma membrane again o Phagocytosis: endocytosis brings solid material into the cell o Pinocytosis: endocytosis brings fluid materials into the cell Exocytosis o Vesicle is formed in the cytoplasm // may form from Golgi apparatus o Moves towards plasma membrane and fuses with plasma membrane o Contents are pushed outside cell o Insulin is secreted from cells in this way

Mitochondria

1m in diameter and 7m in length Mostly protein, but also contains some lipid, DNA and RNA Power house of the cell Energy is stored in high energy phosphate bonds of ATP Mitochondria convert energy from the breakdown of glucose into adenosine triphosphate (ATP) Responsible for aerobic respiration Metabolic activity of a cell is related to the number of cristae (larger surface area) and mitochondria

Cells with a high metabolic activity (e.g. heart muscle) have many well developed mitochondria

Cystic Fibrosis

Caused by a mutation of the Cystic Fibrosis Transmembrane Regulator (CFTR) gene o Covered in Unit 2 Section 3.2.1 CFTR is a plasma membrane protein o Normally, it transports chloride ions out of the cell by active transport o In cystic fibrosis, a mutation alters the tertiary structure of CFTR o The protein fails to reach plasma membrane o Accumulation of Cl- and Na+ (attracted by negative Cl-) within the cell o Secretions are thick as water stays inside the cell due to high internal Na+ (altered water potential) o NB: water always follows Na+ Lungs o "Produce less mucus than normal "1 o Lung surface is dehydrated and mucus adheres to airways o This favours the growth of bacteria causing chronic infection o White cells engulf bacteria and die (phagocytosis) o The DNA from dead inflammatory cells (pus) contributes to thick sputum o Sputum has an increased viscosity and cannot be removed by the ciliary escalator o Obstructs airways and causes further inflammation Pancreas o Thick digestive juice blocks passage from pancreas into small intestine (duodenum)

Obstruction may cause chronic inflammation of the pancreas o Pancreas fails to secrete digestive enzymes o Food is not broken down and not absorbed Sweat o CFTR works differently in the skin o Normally, chloride are transferred from the sweat into the cell o Excessive NaCl remains on the skin - sweat taste saltier than normal o Sweat can be collected and analysed to diagnose CF Slow growth o Less efficient energy/fooduptake due to malabsorption o High energy consumption due to chronic inflammation of the lungs o To compensate, children require high calorie diet (chocolate, crisps) Treatment o Pancreatic enzyme replacement therapy (PERT) to treat fat malabsorption o Fat-soluble vitamin supplements (A, E, D, K) to prevent deficiencies o Inhaled enzyme DNAse breaks down excessive DNA and thin mucus o Antibiotics to treat lung infections (frequent use causes antibiotics resistance)
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Bacteria and Viruses

Both, bacteria and viruses, are called microbes Infectious or communicable diseases are caused by pathogens o Gain entry, colonise tissues, resist defences, damage host tissues

Microscopy o Magnification increases the size of an object o Resolution/resolving power ability to distinguish between adjacent points Calculating magnification o X = size of picture (measure the size of the diagram in the question) o Y = size of object in real life (often given in exam question) o Make sure Y has the same unit as X! If X = mm and Y = m Convert mm to m = X * 1000 o Magnification = Xm / Ym Optical microscope Light 400x (max1500) 2m Electron microscope Electrons 500 000x 1nm / 0,001m Electrons have a small wavelength Thus, higher resolution Present - Dead (vacuum!) Transmission microscope: Electrons pass through internal structure of specimen Scanning microscope: Beams of electrons are reflected

Feature Radiation Magnification Resolution

Vacuum in microscope Specimen is

Absent - Alive or dead - Stained

off specimens surface. Allows a three dimensional view Bacteria

Grow best at optimum conditions (human body) o Constant temperature o Neutral pH o Constant supply of food, H2O, O2 o Mechanism removing waste Classification o Most bacteria require oxygen to survive: aerobic bacteria o Bacteria that are growing in the absence of oxygen: anaerobic bacteria Bacteria are prokaryotes o Nucleus (5m) Contains chromosomes (genes made of DNA which control cell activities) Separated from the cytoplasm by a nuclear envelope The envelope is made of a double membrane containing small holes These small holes are called nuclear pores (100nm) Nuclear pores allow the transport of proteins into the nucleus o Undergo asexually reproduction by binary fission / 2 identical daughter cells Only a small number are pathogens. Pathogens cause disease by: o Damaging our cells; or o Producing toxins; or o Directing our immune system against our own cells

Salmonella

Damage host cells Found in eggs and poultry Causes disease if food is expired and/or undercooked Organism is taken up by epithelial cells in the intestine o Severity depends on ability to invade host cell o Some people are more susceptible than others o Ligand on pathogen must fit onto receptor proteins on host o Structure of receptor protein depends on an individuals genetic coding Host creates a ruffled surface o Invaded cells detach from intestinal wall, creating inflamed lesions o Secretion of large amounts of watery fluid into the lumen of the gut o This causes watery diarrhoea Other symptoms: vomiting, abdominal pain Management o High fluid intake o Often self-limiting, dont require treatment o Severe cases, take stool culture and use antibiotics

Vibrio Cholera

Produces enterotoxins released from bacteria o Enters enterocytes (cells lining the surface of the intestine) by endocytosis o Activates the CFTR protein (cystic fibrosis transmembrane regulator) o Causes secretion of sodium, chloride and bicarbonate ions from enterocytes

Water follows sodium into the intestinal lumen Osmotic loss of up to 10L of water per day! o Results in severe watery diarrhoea of sudden onset o Dehydration leads to death within hours if untreated Giving oral sodium would cause more water to be secreted into the intestine, worse! Giving oral glucose and sodium (oral rehydration therapy) o Glucose is still absorbed through the intestinal wall o This is done by a glucose-sodium co-transporter o Carries one glucose molecule and one sodium ion across the intestine into the blood o Water always follows sodium o Diarrhoea is less severe and body becomes rehydrated Oral rehydration therapy (ORT) also contains potassium and bicarbonate ions o Prevents electrolyte imbalance o Prevents metabolic acidosis
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Tuberculosis (TB)

Cause an attack by the body's own immune system Symptoms o Weight loss o Night sweats o Cough o Rash Transmitted by coughing and sneezing Body tries to destroy the invading bacteria in the lungs But the inflammation causes damage to the surrounding cells Lesions may become hard or spongy, leaving "holes" in the lungs

Treated with a cocktail of antibiotics for 6 month

Ability to Cause Disease

Depends on o Location - what tissue is colonised o Infectivity - how easily a bacterium can enter the host cell o Invasiveness - how easily a bacterium or its toxin spreads within the body o Pathogenicity - how a bacterium causes disease

Antibiotics

Produced as natural secretions by bacterial or fungal cells o Bacteria and fungi are secondary metabolites (produce antibiotics during a late stage of their life cycle) o Antibiotics inhibit growth of natural competitors o Gives antibiotic-secreting population an advantage in colonising it Antibiotics harm pathogenic bacteria by o Bacteriostatic antibiotics that are slowing down their growth rate o Bactericidal antibiotics that kill pathogenic bacteria (in correct concentration) Narrow-spectrum antibiotics (e.g. penicillin) are only effective on a few pathogens Wide-spectrum antibiotics (e.g. chloramphenicol) are effective on many pathogens Prevent formation of bacterial cell wall o Bacteria occupy a solution with a more negative water potential than their own cytoplasm

Without the cell wall, bacteria are exposed to this hostile environment o As a result, bacteria will swell, burst and die o Revision: Water Potential from Unit 1 Section 3-13(b) Prevent formation of bacterial proteins o By inhibiting DNA transcription or mRNA translation o Bacteria are unable to synthesise proteins affects the metabolism of bacteria NOTE: Antibiotics do not affect viruses o Viruses have no cellular structure (such as a cell wall) o Viruses use the host to reproduce and synthesize proteins
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Viruses

Transmitted via o Sexual contact o Placenta (infected woman passing it to her baby) o Receiving blood from an infected person (IV drug abuse)

Human Immunodeficiency Virus (HIV)

Structure o Retrovirus: core contains reverse transcriptase and RNA (2 single strands) o Core is surrounded by a protective coat of protein called capsid o Capsid is covered by a lipid membrane (acquired when HIV leaves cell after replication)

This lipid membrane has antigens and glycoproteins on its surface o Those projections recognize receptors on Tlymphocytes AIDS (Acquired Immune Deficiency Syndrome) o All T-helper cells infected and destroyed o Without T-helper cells, no immune response o People highly susceptible to infections and cancer HIV can change its surface proteins and evade the immune system / vaccination is difficult
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Cycle of Infection

HIV enters body from HIV +ve persons via body fluids such as blood or semen Viral glycoprotein attaches to receptors on cell membrane of T-helper cells HIV enters cell by endocytosis, releasing its RNA and reserve transcriptase into the cytoplasm Reverse transcriptase copies viral RNA strand This forms a double stranded viral DNA in the nucleus of T-helper cell / now called "provirus" Viral DNA is integrated into the host DNA / host cell replicates with provirus Latency period (variable period of time) infection of more cells, but no symptoms Outbreak o Host DNA is transcribed to make new viral RNA o Proteins necessary for capsid and envelope are synthesised by infected host cell New viruses assembled with RNA and proteins leave the cell by exocytosis Viral envelope is constructed from cell membrane of host cell

Reaction to Foreign Material Antigen

Usually a protein (but polysaccharides, nucleic acid and lipids also act as antigens) Self-antigen o Only found on the host's own cells and does not trigger an immune response o As these are proteins, their structure depends on the amino acid sequence o The gene for this sequence is highly polymorphic, having several alleles at each loci o There is great genetic variability between individuals o Thus, antigen is different in other people injection would cause an immune response o There is only 25% chance that siblings will possess an identical antigen (transplant will not be rejected) Non-self-antigen o Found on cells entering the body (e.g. bacteria, viruses, another person's cell) o Can also be displayed by cancer cells o May cause an immune response

Antibody (Immunoglobin Protein)

Secreted by B-lymphocytes and produced in response to a specific (foreign) non-self antigen B-lymphocyte's receptor site matches the non-self-antigen Each antibody is produced by one type of B-lymphocyte for only one type of antigen Has a Y-shape o The two ends of the Y are called the Fab fragments o The other end is called the Fc fragment

Fab fragments are responsible for the antigenbinding properties o Fc fragment triggers the immune response B cells divide and form memory cells and antibodysecreting plasma cells Glossary o Agglutination makes pathogens clump together o Antitoxins neutralise toxins produced by bacteria o Lysis digests bacterial membrane, killing the bacterium (phagocytosis) o Opsonisation coats pathogen in protein that identifies them as foreign cells
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Phagocytosis

White cells (phagocytes) contain digestive enzymes within lysosomes o Neutrophils primarily engulf bacteria o Macrophages engulf larger particles; including old and infected red blood cells Found in blood, lymph systems and tissues o Squeeze through gaps in the walls of venules to enter tissues o This allows them to move faster to tissues infected with pathogens Mechanism o Phagocytes are attracted by chemotaxis o Opsonisation by antibodies Bacteria becomes coated with antibody As a result, binding between bacteria and phagocytes is improved o Phagocytes form pseudopodia around the particle o This positions the particle into a phagocytic vacuole (also called phagosome)

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Lysosome fuses with the phagosome Intracellular killing by digestive enzymes from the lysosome Pus is formed at the site of infection if no extensive vasculature is present

Types of Immune Response

Lymphocytes undergo maturating before birth, producing different types of lymphocytes Humoral response - B lymphocytes o Produce and release antibodies into blood plasma o Produce antibodies from B plasma cells o Direct recognition of foreign antigen Cellular response - T lymphocytes o Bind to antigen carrying cells and destroy them and/or activate the humoral response o Recognize foreign antigens displayed on the surface of normal body cells Primary response produces memory cells which remain in the circulation Secondary response new invasion by same antigen at a lower state. Immediate recognition and distraction by memory cells - faster and larger response usually prevents harm

B-Lymphocytes: Humoral Response

Production of antibodies in response to antigens found on pathogens not entering cells (bacteria) Each B-lymphocyte (B cell) recognizes one specific antigen Primary response o Antigen binds to specific Fab fragment of B cell

This produces a short and weak response T helper cells are required to trigger the true potential of B cells o Once activated, the B cell grow and produce many clone cells o Clone cells have the same Fab fragment that recognizes the same antigen o Most differentiate into plasma cells Secrete large amounts of antibodies Bind to antigens and mark them for destruction o Some differentiate into memory cells Secondary response o Exposure of same antigen causes activation of memory cells o They immediately recognize the antigen o Antibodies are produced more rapidly and in larger amounts

T-Lymphocytes: Cell-Mediated Response

Pathogens that quickly enter cells are more difficult to remove (viruses, tuberculosis) Infected cell is directly destroyed / no antibodies involved This is done by binding to the self and non-self antigen o Prevents destruction of harmless cells o Self antigen is a MHC (Major Histocompability Complex) protein present on almost all body cells o Non-self antigen (from viruses, bacterium, cancer, foreign cell, parasite) is processed and displayed on the surface of the infected cell Primary response o Macrophage

Engulfs the pathogen and processes its foreign antigen Non-self antigen is transported to the plasma membrane surface of the macrophage Now called an antigen presenting cell (APC) o T Helper cells (Th cells) Recognize foreign antigen on APC Activates cytotoxic T cells and B cells to destroy the infected cell o T killer cells (cytotoxic T cells) Must recognize self and non-self antigen to attach to infected cell Directly kill pathogen by injecting proteases into the infected cell Detach to search for more foreign cells o T-Suppressor cells switch off the T and B cell responses when infection clears Secondary response o Some T cells differentiate into T-memory cells o Remain in the circulation and respond quickly when same pathogen enters body again HIV destroys T-helper cells o Other immune cells are not activated o Humoral response cannot be launched without Th cells / require co-stimulation of Th cells o No immune response in patients with AIDS

Immunity and Vaccines

Vaccination is an artificial active immunity Types o Live attenuated: organism is alive but has been modified/weakened so that it is not harmful

MMR (measles, mumps, rubella) - vaccine does NOT cause autism! BCG for tuberculosis o Inactivated: dead pathogen but antigen is still recognised and an immune response triggered Pertussis (whooping cough) Poliomyelitis o Toxoid: vaccine contains a toxin Diphtheria Tetanus o Subunit: contains purified antigen that is genetically engineered rather than whole organism Haemophilus influenza b - causes epiglottitis, meningitis Meningococcal C - causes serious septicaemia, meningitis Pneumoccocal - causes meningitis which results in permanent disabilities in >30%! Vaccine may cause swelling, mild fever, and malaise NEVER give live vaccines to children with an impaired immune system! NEVER give vaccines if a child is ill (has a fever)

Natural

- Acquired antibodies (via placenta, breast milk) Artificial Vaccination - Injection of (immunisation) (Injection of the antigen antibodies from an in a weakened form) artificial source, e.g.

Active (Antibodies made by the human immune system, long term acting due to memory cells) - Response to disease - Rejecting transplant

Passive (GivenAntibodies, short term acting)

Differences

anti venom against snake biter - Antibody in response - Antibodies provided to antigen - No memory cells - Production of memory - Short lasting cells - Long lasting

Monoclonal Antibodies (Magic Bullets)

Hybridoma o B cells are fused with tumour cells in the lab o Divide rapidly to form a clone of identical cells o Specific monoclonal antibodies are continuously produced and useful as Tumour markers (antigens not present on noncancer cells / attach to cancer cells only)

Anti-cancer drugs attached to monoclonal antibodies - deliver drug directly to cancer cells, fewer side effects Uses of monoclonal antibodies o Monoclonal antibody is an antibody that is of just one type o Used to target the treatment of cancer cells or to screen (AIDS) in contaminated blood o Antibody direct enzyme prodrug therapy techniques (ADEPT) Monoclonal antibodies are tagged with an enzyme that converts the prodrug (inactive drug) to an active form that kills cells (i.e. is cytotoxic) The prodrug is injected in high conc Attached to a monoclonal antibody, enzyme activates the drug and kills only cancer cells o In immunoassays, they can be labelled (radioactively) making them easy to detect o In the enzyme-linked immunosorbant assay (ELISA) technique, they are immobilised on an inert base and a test solution is passed over them Target antigen combines with immobilised monoclonal antibodies Second antibody attaches with an enzyme and binds to the monoclonal antibodies and to the target antigen as well Substrate is added which is converted to a coloured product by the added enzyme Conc. of colour tells us the amount of antigens present in the test solution o Used to detect drugs in urine of athletics or in home pregnancy tests (where an antigen in human chorionic gonadotrophin (hCG) is secreted by the placenta)

Transplanted organs have non-self-antigens triggering antibodies to attack the organ, leading to its rejecting T-Lymphocytes are needed for B-lymphocytes to function Monoclonal antibodies against T-lymphocytes can be used to prevent B-lymphocytes from functioning, thus blocking the rejection of transplanted organs [EXAM] Helping to diagnose between two pathogens because Antigens are on cell-surface membrane Monoclonal antibody reacts with specific antigen only Thus, detects presence of special bacteria because of a different antigen on another, different bacteria

Anatomy

Heart consists of 4 chambers o Right atrium (RA) o Right ventricle (RV) o Left atrium (LA) o Left ventricle (LV) Blood flow o Right atrium receives blood from Superior vena cava (SVC) - carries blood from upper body (head, arms) Inferior vena cava (IVC) - carries blood from lower body (chest, abdomen, legs) o Blood flows from right atrium, across tricuspid valve, into right ventricle o Blood leaves right ventricle and enters pulmonary artery

Backflow into RV prevented by semilunar pulmonic valve Deoxygenated blood arrives at lungs via pulmonary artery Oxygenated blood leaves lungs via pulmonary vein o Blood from pulmonary vein enters left atrium o Blood flows from left atrium, across mitral valve, into left ventricle o Left ventricle has a thick muscular wall / generates high pressures during contraction o Blood from LV is ejected, across aortic valve, into aorta Muscle of left ventricle is thicker than right ventricle o Pressure in aorta is higher than pulmonary artery o Left ventricle must generate more pressure to overcome pressure of aorta o Therefore, thicker muscle required in left ventricle Tricuspid and mitral valves are atrioventricular (AV) valves o Have fibrous strands (cordae tendinae) that attach to papillary muscles o Papillary muscles contract during ventricular contraction o Generate tension on valve via cordae tendinae to prevent AV valves from flapping back into atria Semilunar valves (pulmonic and aortic) do not have these attachments

Cardiac Cycle

Atria receive blood from veins and store it prior to each heart beat Systole: period of contraction by heart muscle

Diastole: period of relaxation by heart muscle Atrial systole o Both atria contract and move blood across AV valves into ventricles o This reduces volume of atria but increases pressure Pressure of RA > RV - forces tricuspid valve to open Pressure of LA > LV - forces mitral valve to open Ventricular systole o Contraction of ventricles increases pressure o AV valves close as blood is forced against them 1st heart sound o This prevents backflow into atria o Instead, blood is ejected into arteries through aortic and pulmonary valves Ventricular diastole o End of cardiac cycle, all chambers relax o Aortic and pulmonary valves close 2nd heart sound o This prevents backflow into ventricles o Atria fill up again to start next cycle o Volume increases while pressure decreases

Electrical activity

Heart has unique ability to beat (contract) on its own Assisted by nerves and hormones in blood but can function without them Sinoatrial (SA) node o Located at the top right atrium o Also known as the "natural pacemaker" controlling heart rate

Increases with physical activity and decreases when relaxing o Sends impulses across the atria to the AV node o Cause contraction of atria Atrioventricular (AV) node o Located between atrium and ventricle o Ventricles are isolated from atria o Impulse must pass through AV node to travel across ventricles AV node is connected to the Bundle of His o Branches into a right bundle (to right ventricle) and left bundle (to left ventricle) o Fibres that branch out to distant ventricles are called Purkinje Fibers o Cause contraction of ventricles
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Pressure Changes

Isovolumetric contraction o Ventricles start to contract o Intraventricular pressure rises and causes AV valves to close o Ventricles are no longer filled with blood and volume says the same o Pressure is not high enough to open semilunar valves Pressure in LV > aorta o Semilunar valves open o Ventricular volume decreases o Blood is ejected into aorta Pressure in LV < aorta o Back pressure causes blood to move back and semilunar valves to shut Isovolumetric relaxation

AV and semilunar valves are closed o Lasts until pressure in atria > ventricles Pressure atria > ventricles o Ventricles are filled o Atrial contraction/systole - final amount of blood is emptied into ventricles immediately prior to next phase of isovolumetric contraction of ventricles
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Blood vessels Arteries

Pulmonary artery o Transports deoxygenated blood from right ventricle into lungs Systemic arteries o Transport oxygenated blood from left ventricle to body tissues o Carry 10% of total blood volume o Blood is pumped from left ventricle into large elastic arteries o Elastic arteries become smaller muscular arteries o Muscular arteries branch into smaller arterioles (smallest arteries) o Arterioles regulate blood flow into tissue capillaries Made up of 3 layers: o Tunica intima (innermost layer) Simple squamous epithelium Surrounded by a connective tissue basement membrane with elastic fibres o Tunica media (middle layer) Smooth muscle and usually thickest layer Changes vessel diameter to regulate blood flow and BP o Tunica adventitia (outermost layer) Attaches vessel to surrounding tissue

Connective tissue with varying amounts of elastic and collagenous fibers Compared to veins, arteries have a relatively small lumen

Veins

Pulmonary veins o Transport oxygenated blood from lungs to left atrium Systemic veins o Transport deoxygenated blood towards the heart o Carry 70% of total blood volume o After blood has passed through the capillaries, it runs into venules (smallest veins) o Become progressively larger until they reach the right atrium o Medium and large veins have valvesthat prevent backflow of blood due to gravity Made up of same 3 layers as arteries o BUT less smooth muscle and connective tissue o Makes walls of veins thinner with less pressure larger lumen o Hold more blood than arteries

Atherosclerosis

Hardening of arteries o Tunica intima thickens with deposits of Cholesterol Fibrous (scar) tissue Dead muscle cells Blood platelets o Arteries become less elastic and partially narrowed BP which in turn accelerates atherosclerosis

Leads to endothelium damage and weak walls Mechanism o Excess cholesterol leaks from lipoproteins (LDLs) o Deposited on arterial walls o Macrophages (white blood cells) are trapped within cholesterol o Release free radicals which damage the arterial wall o Activates blood platelets which stick to damaged areas releasing clotting factors (thromboxanes) o Forms a plaque which may rupture to produce a thrombus o Circulating thrombus is called an embolus o Embolus may lodge elsewhere in the circulation (brain, heart arteries) o NB: healthy arteries produce anti-clotting factors (prostaglandins) don't form clots Factors that aggravate atheroma formation / atherosclerosis: o Hypertension (BP) o Smoking (release of free radicals) o High LDL and low HDL o NB: they all cause endothelial damage

Aneurysm

Weak arterial walls may burst leading to severe loss of blood (haemorrhaging) Brain aneurysm is called a stroke

Deep Vein Thrombosis

Clots are formed by o Endothelial damage (see atherosclerosis)

Altered blood components (dehydration, too many platelets) o Altered blood flow (stasis of veins) this is what causes DVT Prolonged immobility Such as paralysis, long-distance flights, lying down for weeks after surgery Thrombus often originates in calf veins Inflammation of vein walls destroys vein valves Causes leg pain, swelling, and redness Elastic support stockings required for life Prevented by taking aspirin or warfarin which inhibit blood clotting
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Coronary Heart Disease

Atherosclerosis causes arteries to become narrowed o More force required to move blood through narrowed vessels o Blood pressure increases Stable angina o exercise leads to oxygen requirements by heart o Narrowed arteries prevent more blood to pass through o Shortage of blood to heart muscle causes chest pain o Cells do not die as some blood can still pass through o Pain only occurs during activity but not at rest Myocardial infarction (MI) o Coronary artery is totally blocked by a thrombus/embolus o No blood supply to heart muscle and cells die o Irreversible if not treated within 90min Heart failure

Prolonged blockage of artery causes damage to heart muscle contractions / cardiac output / pressure generated / less blood leaves heart More blood is stored: on the right side of the heart enlarged heart in veins swollen legs and enlarged liver

Lifestyle Cholesterol

Needed for o Vitamin D production in skin o Sex hormone production in gonads and adrenal glands o Making cell membranes o Produce bile acid (salts) Has properties similar to fats soft, waxy, and insoluble (difficult to remove if deposits form) Transported in blood from liver to tissues o Safe transport is needed due to its insolubility o Achieved by lipoproteins, which are soluble fatty proteins o These are wrapped around cholesterol o Normally, only small amounts of free cholesterol escape

LDL

Low density lipoproteins Carries cholesterol from liver to tissues Normally, some cholesterol 'leaks' from the lipoprotein and is absorbed to build cell membranes

Excess LDL/cholesterol too much cholesterol leaks out and causes atherosclerosis

HDL

High density lipoprotein Picks up cholesterol from arterial walls and carries it away from tissues Travels to liver where cholesterol is removed with bile

Smoking

antitoxidants (vitamins), more damage due to release of free radicals by phagocytes [exam] Nicotine constricts arteries causing platelets to stick together vasoconstriction heart must work harder to force blood through increases BP [exam] BP causes damage to blood vessel lining / endothelium / collagen o Leads to rise on blood platelets and makes them more sticky / form a plug / adhere to collagen fibres o Release of thromboplastin/thrombokinase o Fibrinogen converted to insoluble fibrin o Platelet plug trapped by fibrin mesh Raises conc. of fibrinogen (in blood) increased risk of clotting LDL causes more cholesterol to leak out in blood Carbon monoxide reduces the efficiency of the blood in terms of carrying oxygen o Haemoglobin combines with CO more readily than with oxygen forms carboxyheamoglobin o Associated with plaque formation

Principle CHD = heart muscle receives inadequate amount of blood or oxygen/(coronary) blood supply reduced

Treatment

Medication o Beta blockers reduce heart rate and reduce oxygen required by heart o Aspirin prevents blood clotting and thrombosis formation o ACE inhibitors stabilize plaques prevent thrombus to break off o Statins reduce LDL and increase HDL Angioplasty o Deflated balloon-like device is passed up to the heart via the aorta o Guided into damaged coronary artery and inflated to stretch the artery Heart by-pass graft o Leg veins and arteries from chest are used to bypass the blocked region of the coronary artery o Involves open heart surgery Reperfusion therapy after a myocardial infarction o Angioplasty done within 90 minutes of onset of chest pain o May prevent irreversible damage to the heart muscle

Prevention

1. Screen population for o High BP o High cholesterol

Uncontrolled diabetes o Smoking? Unhealthy diet? No exercises? o Men over 55 and women over 65 are at highest risk 2. Monitor the behaviour of the heart during exercise o Difficult but encouraging the population to adopt a more healthy lifestyle from an early age is important o Often leads to changes in diet and weight management 3. Giving up smoking and reducing alcohol intake o Reduces blood pressure o Coronary heart disease is a long-term degenerative disease, starts at birth
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Capillaries

Smallest, most numerous blood vessels o Carry blood from arteries to veins o Blood flows from arterioles capillaries venules o Size of lumen is diameter of erythrocytes o Thin wall is composed of endothelium (single layer of overlapping flat cells) Function: exchange materials between blood and tissue cells (O2, CO2, nutrients, wastes) Capillary distribution varies with metabolic activity of body tissues o Skeletal muscle, liver, and kidney have extensive capillary networks o They are metabolically active and require an abundant supply of oxygen and nutrients o Connective tissue have less abundant supply of capillaries o Epidermis of skin and lens, and cornea of eye lack capillaries Flow of blood is controlled by precapillary sphincters o Found between arterioles and capillaries

Smooth muscle allows them to contract and reduce blood flow Hydrostatic pressure is created by the heart which pumps blood into arteries At the arteriole end o Hydrostatic pressure > water potential o Plasma proteins lower water potential o H2O, small molecules, and fluid are forced out through permeable capillary wall o Plasma proteins are not forced out as they are too large At the venule end o Water potential > hydrostatic pressure (due to lower volume) o Fluid flows back into blood with waste products produced by cells
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Blood Plasma

Plasma is a liquid containing proteins, inorganic salts, amino acids, vitamins, hormones Main plasma proteins are albumin, globulins, and fibrinogen Albumin maintains osmotic pressure and acts as a transport protein for various substances Globulins are mainly antibodies Fibrinogen is involved in clotting process

Oedema

Accumulation of tissue fluid in interstitial space capillary hydrostatic pressure due to increased blood volume o Heart failure

Impaired venous valves of leg (backflow of blood) capillary permeability due to inflammation Impaired fluid return to blood due to low protein levels in blood plasma o This colloid osmotic pressure of plasma Fluid fails to return to blood at venous end Fluid accumulates in interstitial space o Caused by Low protein absorption from gut Liver disease (proteins not produced) Kidney disease (proteins leak into urine) Blockage of lymphatic vessels o Small amounts of plasma protein leak out of blood o Usually transported back into the circulation by lymphatic vessels o Blocked vessels causes accumulation of protein in interstitial space o This colloid osmotic pressure o Fluid diffuses from blood into interstitial space Oedema increases diffusion pathway of nutrients and oxygen between blood and cells
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