year 1 revision sheet, Summaries of Medicine

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Typology: Summaries

2019/2020

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Epithelium
Derivatives from the
three germ layers
- Endoderm: skin, CNS and PNS, neural crest cells, eyes, internal
ears
- Mesoderm: bones, ct, urogenital, CVS
- Ectoderm: gut and gut derivatives
- Just remember this; extra: ectoderm skin epidermis, sweat
glands, duct oral surface, vagina, anus
Common properties
of epithelial cells
1. All with junctional structures (desmosome, hemidesmosome)
2. All rest on basement membrane
3. Cytokeratin as intermediate filament
4. Avascular
Composition of
basement
membrane
- Basal lamina + protein layer + lamina recularis
Basal lamina
- Lamina lucida (cell membrane) + lamina densa (collagen IV)
How do cancer cells
invade tissues
- Basement membrane contains collagen IV (lamina densa)
cancer cells secrete type IV colleganase invasion
Protein layer
- Collagen VII + fibrilla
Lamina reticularis
- Collagen III
Summary of
collagen types
present in
basement
membrane
- IV (from epithelium)
- VII (protein layer)
- III (from ct)
Function of
cytokeratin
- Cell adhesion via desmosome and hemidesmosome
- Tumour marker
Replacement by
stem cells
- Intestinal epithelium: base of crypts
- Skin epithelium: stratum basale
Metaplasia
- Faced with a chronic change in environment change from
one type to another e.g. smoking causes squamous metaplasia
in respiratory epithelium
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Epithelium Derivatives from the three germ layers

  • Endoderm: skin, CNS and PNS, neural crest cells, eyes, internal ears
  • Mesoderm: bones, ct, urogenital, CVS
  • Ectoderm: gut and gut derivatives
  • Just remember this; extra: ectoderm → skin epidermis, sweat glands, duct oral surface, vagina, anus Common properties of epithelial cells
  1. All with junctional structures (desmosome, hemidesmosome)
  2. All rest on basement membrane
  3. Cytokeratin as intermediate filament
  4. Avascular Composition of basement membrane
  • Basal lamina + protein layer + lamina recularis Basal lamina - Lamina lucida (cell membrane) + lamina densa (collagen IV) How do cancer cells invade tissues
  • Basement membrane contains collagen IV (lamina densa) → cancer cells secrete type IV colleganase → invasion Protein layer - Collagen VII + fibrilla Lamina reticularis - Collagen III Summary of collagen types present in basement membrane
  • IV (from epithelium)
  • VII (protein layer)
  • III (from ct) Function of cytokeratin
  • Cell adhesion via desmosome and hemidesmosome
  • Tumour marker Replacement by stem cells
  • Intestinal epithelium: base of crypts
  • Skin epithelium: stratum basale Metaplasia - Faced with a chronic change in environment → change from one type to another e.g. smoking causes squamous metaplasia in respiratory epithelium

Simple squamous 1. Mesothelium → serous cavity (pleura, peritoneum including mesentery, pericardium)

  1. Alveoli
  2. Endothelium
  3. Parietal layer of Bowman’s capsule, thin segment of loop of Henle Simple cuboidal 1. Kidney tubules
  4. Small ducts of glands e.g. pancreas
  5. Thyroid gland Simple columnar 1. Stomach
  6. Intestinal mucosa (microvilli)
  7. Gall bladder and bile ducts Pseudostratified (ciliated, with goblet cell)
  8. Respiratory passages: trachea, bronchi
  9. Epididymis (stereocilia) Stratified cuboidal - Sweat glands Stratified columnar - Conjunctiva of the eye Stratified squamous (non-keratinised)
  • Moist surfaces
  1. Oesophagus
  2. Vagina
  3. Anterior corneal surface
  4. Part of oral cavity Stratified squamous (keratinised)
  • Dry surfaces
  1. Epidermis of skin
  2. Part of oral cavity Transitional - Urinary passages, including bladder Apical specialisation
  3. Microvilli
  4. Stereocilia
  5. Cilia
  6. Flagella Microvilli - Enterocytes
  • Actin filament

Serous secretion - With enzymes

  • Basophilic cytoplasm
  • Acinar cells of pancreas, parotid salivary cells Mucous secretions - Mucin (rich in proteoglycan) → dehydration to form mucus
  • GI tract mucous glands Mucous membrane - Epithelium + lamina propria (ct) + muscularis mucosae Serous membrane - Mesothelium + ct

Connective tissues Developmental origin

  • Embryonic mesenchyme (mesoderm) Specialised ct - Cartilage and bone
  • Adipose
  • Blood, lymphatic, hemopoietic Loose areolar 1. Mesentery (peritoneum)
  1. Wharton’s jelly (umbilical cord)
  2. Lamina propria in GI tract (mucosa)
  3. Hypodermis Dense irregular - Dermis (papillary) Dense regular - Tendon
  • Ligament
  • Aponeurosis Ct composition - ECM + cells ECM composition - Ground substance (proteoglycan + glycoprotein) + fibrous components Ground substance - Amorphous
  • Hydrated
  • PAS +ve Proteoglycan - Examples: syndecan, aggrecan
  • Structure: core protein + glycosaminoglycan
  • GAG: amino sugar, highly extended and osmotically active
  • Major GAG: hyaluronic acid, chondroitin sulphate and dermatan sulphate, heparan sulphate and heparin, karatan sulphate
  • Hyaline cartilage with proteoglycan aggregate

Cellular components

  • Fibroblasts
  • Macrophages
  • Mast cells
  • Plasma cells
  • Leukocytes
  • Adipocytes Fibroblasts - Most common cell type in ct
  • Fibrocyte → fibroblast
  1. Synthesise fibrous components (fibroblast in type 1 and 3 collagens; 1: dermis, tendon; 3: reticular fibre) and ground substances i.e. ECM
  2. Precursor for smooth muscle cell, adipocyte, chondroblast (type 2 collagen, hyaline cartilage), osteoblast (in bone, type 1 collagen)
  • Excessive → fibrosis Macrophages - From circulating monocytes
  • Pathologic conditions → multinucleated giant cells
  • Surface receptors for: Fc, C
  • Mononuclear phagocyte system (erythrocyte regeneration, body defence)
  1. Lysosomal enzymes → phagocytosis
  2. Antigen-presentation
  3. Secretion of growth factors and cytokines (TNF-a, IL- 1 )
  4. LOX pathway (→ leukotrienes) active in macrophages
  • Examples: Kupffer cells (liver sinusoids, phagocytose RBC), alveolar macrophages, microglia, osteoclasts Mast cells - Content: histamine, heparin, protease, ECF-A, leukotrienes
  • Granules are metachromatic
  • Surface receptor for: IgE
  • Involved in immediate hypersensitivity reactions → anaphylactic shock (serious allergy) Plasma cells - Few in ct
  • Basophilic cytoplasm, prominent Golgi complex, abundant rER, heterochromatin clump

Human skin Developmental origin

  • Ectoderm → epidermis (stratified squamous)
  • Mesoderm → dermis (ct), skin appendages (paraxial mesoderm → dermatome → dermis) Epidermis: cellular components
  1. Keratinocytes
  2. Melanocytes
  3. Langerhans’s cells (dendritic cells, mid-epidermis) Keratinocytes - Held together by desmosome, primarily visible in stratum spinosum
  • Basal membrane → (differentiate) stratum corneum Melanocytes - 1 per 10 keratinocytes, stratum basale
  • Melanocytic nevi: moles
  • Melanoma: malignancy Langerhans’ cells - Antigen-presentation to T cells
  • Induction of delayed typed hypersensitivity Epidermis: layers - Stratum basale → stratum spinosum → stratum granulosum → stratum corneum (corneocytes) Corneocytes - Flattened keratinocytes
  • Filled with keratin, filaggrin, ceramides, free sterols, free FA Dermo-epidermal junction
  • Protein + glycoprotein
    1. Adhesion 2) cellular migration for wound healing 3) cellular signalling (epithelial-mesenchymal) Dermis: cellular and fibrous components
  1. Fibroblasts
  2. Mast cells
  3. Collagen (1 and 3 → dermal interstria; 4 → basal lamina)
  4. Elastic fibres Subcutis / panniculus / hypodermis
  • Loose areolar
  • Arterioles, venules, lymphatics Skin appendages - Nails
  • Adnexal structures: pilosebaceous unit, eccrine / apocrine glands

Apocrine sweat glands

  • Connected to hair follicles
  • Low secretary input
  • Lipid-rich secretion
  • Axilla, genitalia, mammary areas Eccrine sweat glands
  • Not connected to hair follicles, open directly to skin surface
  • Bullous secretory coil, secretory duct, opening pore
  • Distributed over whole body surface
  • Genetically absent → hyperthermia (involved in active sweating) Insensible perspiration vs active sweating
  • Insensible perspiration: passive water evaporation
  • Active sweating: involves eccrine glands Stem cells - Follicles
  • Inter-follicular dermis
  • Sebaceous glands

Neural integration Overview N2 receptors location

  • Only ANS: PS and S M receptors location
  • Only PNS N1 receptor location
  • Only somatic Sympathetic division: overview
  • Short preganglionic (ganglia near spinal cord)
  • Preganglionic neurons: T1-L2 (lateral grey horns of spinal segments)

Adrenergic receptors PS division: overview

  • Effects are specific and localised PS innervation - Long preganglionic fibres, short postganglionic fibres
  • Preganglionic neurons: brain stem and sacral segment of spinal cord Pre-ganglionic neurons: S vs PS
  • S: lateral grey horns of spinal segments (T1-L2)
  • PS: brain stem (N3, N7, N9, N10), sacral segment of spinal cord (S2-S4, pelvic nerves)

Types of post- ganglionic fibres in PS

  • N3: ciliary ganglion → intrinsic eye muscles (oculomotor)
  • N7: pterygopalatine and submandibular ganglia → nasal glands, tear glands, salivary glands (facial)
  • N9: otic ganglion → parotid salivary gland (glossopharyngeal)
  • N10: intramural ganglia → visceral organs of neck, thoracic cavity, most of abdominal cavity (vagus, 3/4 of parasympathetic outflow)
  • Pelvic nerves: intramural ganglia → visceral organs in inferior portion of abdominopelvic cavity Nicotinic receptors - Voltage-gated ion channels
  • Excitatory Muscarinic receptors

- GCPR

  • Excitatory: depolarisation → smooth muscle contraction
  • Inhibitory: hyperpolarisation → brachycardia

Neural architecture CNS - Small amount of ct or ECM

  • Dense fibrous network from neuron and neurophil processes Nerve fibres composition
  • Endoneurium: enclose axons and Schwann cells
  • Perineurium: enclose fascicle
  • Epineurium: enclose fibre Neurons: shape - Unipolar: one neurite (invertebrate neuron)
  • Bipolar: retina, olfactory mucosa, inner ear cochlear, vestibular ganglia
  • Pseudounipolar: bipolar → unipolar (spinal ganglia including dorsal root ganglion and most cranial ganglia)
  • Multipolar: spinal motor, hippocampal pyramidal, Purkinje cell of cerebellum not to be confused with Purkinje fibre in cardiac muscles
  • Can have more than one dendrite Nissl body - rER with rosettes of ribosomes → site of protein synthesis
  • Nissl staining
  • LM Axons - Axoplasm: lacks Golgi, rER, free ribosomes, mRNA → no protein synthesis Collaterals - Branching at distal ends of axons Axon hillock and initial segment
  • Transition zone between soma and axon Axonal transportation
  • Anterograde and retrograde flow → bidirectional transport of molecules
  • External transport mechanism → retrograde transmission → damage cell bodies Sensory nerve endings
  • Pacinian corpuscles: pressure
  • Meissner corpuscles: touch
  • Free nerve endings: pain
  • Muscle spindles: reflex Simple receptors - Neurons with free nerve endings
  • Myelinated or unmyelinated axons

Membrane excitability Non-gated channels - Always open

  • Passive ion influx
  • Resting potential Voltage-gated channels
  • Open only when membrane potential exceeds threshold
  • Mainly: action potential Resting stage permeability
  • Permeability to K+ ≫ Na+
  • Open channels in membrane predominantly K → resting potential near potassium equilibrium potential Resting membrane potential
  • Inside: negative
  • Dependent on relative permeability of each ion
  • Permeability ratio dictates resting membrane potential Na/K ATP pump - Primary active transport
  • Ionic gradient maintained by Na/K pump Na and K voltage- gated channels
  • Na: one activation (M) one inactivation (H)
  • K: one activation Depolarisation - Exceeds threshold → sufficient number of voltage-gated channels open to allow net movement of +ve charges (Na influx > K efflux)
  • M gate opens Na fast positive feedback cycle
  • Sodium M gates open → Na influx → change electrochemical gradient → further depolarisation

Repolarisation and K slow negative feedback cycle

  • Sodium H gates close → Na don’t enter neuron + active transport out of membrane Experimental evidence
  • Patch clamp technique Absolute refractory period
  • Threshold: infinity
  • H gates closed although M gates are opened
  • K channels open to bring about repolarisation Relative refractory period
  • Threshold higher than normal
  • K channels still open → more K efflux → membrane potential more negative than resting potential + closer to potassium equilibrium potential
  • Not all Na channels available (M gates closed)
  • H gates reopen → Na channels ready for activation again upon depolarisation