1. Body Fluids
Section A, Group 2
ALFONSO, ALJAMA, ALUZAN
AMURAO, ARELLANO, ARROYO

2. Water
 Predominant chemical component of living
organisms
 Universal Solvent
 Has a dipolar structure and exceptional capacity
for forming hydrogen bonds.

3. pH Scale
 The acidity of aqueous solutions is generally
reported using the logarithmic pH scale.
 Bicarbonate and other buffers normally maintain
the pH of extracellular fluid between 7.35 and
7.45

4. pH Scale

5. Factors for Regulation of Water
Balance
 Depends upon hypothalamic mechanisms that
control thirst.
 On Antidiuretic Hormone (ADH)
 Evaporative loss
 Certain diseases like Diabetes Insipidus

6. Water as an Ideal Biologic
Solvent

7. Water Molecules form Dipoles
 A water molecule is an irregular, slightly skewed
tetrahedron with oxygen at its center.

8. Water Molecules Form Dipoles
 Water is a dipole
 Water, a strong dipole, has a high dielectric
constant.
 Its strong dipole and high dielectric constant
enable water to dissolve large quantities of
charged compounds such as salts.

9. Water Molecules Form Hydrogen
Bonds
 Hydrogen bonding favors the self-association of
water molecules into ordered arrays .

10. Water Molecules Form Hydrogen
Bonds
 Hydrogen bonding profoundly influences the
physical properties of water and accounts for its
exceptionally high viscosity, surface tension, and
boiling point.
 Hydrogen bonding enables water to dissolve many
organic biomolecules that contain functional
groups which can participate in hydrogen bonding.

11. Interaction with Water Influences
the Structure of Biomolecules

12. Covalent & Noncovalent Bonds
Stabilize Biologic Molecules:
 These forces (covalent and noncovalent bonds),
which can be either attractive or repulsive, involve
interactions both within the biomolecule and
between it and the water that forms the principal
component of the surrounding environment.

13. Hydrophobic Interactions

14. Electrostatic Interactions
 Interactions between charged groups shape
biomolecular structure.
 Electrostatic interactions between oppositely
charged groups within or between biomolecules
are termed salt bridges.

15. Van der Waals Forces
 Van derWaals forces arise from attractions
between transient dipoles generated by the rapid
movement of electrons on all neutral atoms.

17. Water is an Excellent
Nucleophile

18. Water is an excellent nucleophile
 Metabolic reactions often involve the attack by
lone pairs of electrons on electron-rich molecules
termed nucleophiles on electron-poor atoms
called electrophiles.
 Nucleophiles and electrophiles DO NOT
necessarily possess a formal negative or positive
charge.

19. Water is an excellent nucleophile
 Water, whose two lone pairs of sp3 electrons bear
a partial negative charge, is an excellent
nucleophile
 Nucleophilic attack by water generally results in
the cleavage of the amide, glycoside, or ester
bonds that hold biopolymers together. This
process is termed hydrolysis.

20.  An example of a cleavage of an amide link

21. Water is an excellent nucleophile
 Conversely, when monomer units are joined
together to form biopolymers such as proteins or
glycogen, water is a product.

22. Water Molecules Exhibit a Slight but
Important Tendency to Dissociate:
 Since water can act both as an acid and as a base,
its ionization may be represented as an
intermolecular proton transfer that forms a
hydronium ion (H3O+) and a hydroxide ion (OH−):

23. Distribution of Body Water

24.  Total body fluid is distributed
between two compartments:
 Extracellular fluid
 interstitial fluid
 blood plasma
 Intracellular fluid

25. Transcellular Fluid
 small compartment containing body fluids formed by
the secretion of epithelial cell and is contained within
epithelial lined spaces
 includes fluid in the
synovial, peritoneal, pericardial, and intraocular
spaces, as well as the cerebrospinal fluid
 specialized type of extracellular fluid
 constitute about 1 to 2 liters.

27. In an average 70-kilogram adult
human:
 Total body water is about 42 liters or 60 percent of
the body weight
 This percentage can change depending on:
 Age
 Gender
 Degree of obesity.

28. Age and Body Fat

29. Gender and Body Fat
 Women normally have more body fat than men
 They contain slightly less water than men in
proportion to their body weight

31. Extracellular and Intracellular Fluid
 cell membrane is semipermeable, only water and
small, noncharged molecules can move freely
between interstitial and intracellular compartment.
Ion can not cross easily.
 All kinds of ionic pump or channel on cell membrane
determine the uneven distribution

33. Extracellular and Intracellular Fluid
 ICF and ECF are different in ionic composition

34. Intracellular Fluid
 About 28 of the 42 liters of fluid in the body are inside
the 75 trillion cells
 Constitutes about 40 percent of the total body weight
 Each cell contains its individual mixture of different
constituents, but the concentrations are similar from
one cell to another
 Composition of cell fluids is remarkably similar even in
different animals

35. Extracellular Fluid
 All the fluids outside the cells
 Account for about 20 percent of the body weight, or about 14 liters in a normal
70-kilogram adult
 Two largest compartments: (1) interstitial fluid  more than three fourths of
the extracellular fluid, and (2) plasma  almost one fourth of the extracellular
fluid, or about 3 liters
 *Plasma - non-cellular part of the blood
 - exchanges substances with the interstitial fluid (pores of the capillary
membranes)
 Constantly mixing  plasma and interstitial fluids have about the same
composition except for proteins ( [] in the plasma)

37. Hypervolemia
 Term used for fluid overload, overhydrated and
water excess
 It occurs when the body takes in more water than
it excretes *
 Factors that cause Hypervolemia:
 Cardiac failure
 Renal failure (Kidney’s Damage)
 High sodium intake
 Over infusion of intravenous fluids.

38. Observations related to fluid
balance

39. Hypervolemia
 Infants are especially likely to develop
overhydration (first month of life)*
 For adults, drinking too much water rarely causes
overhydration when the body's systems are
working normally
 Brain- the organ most vulnerable to the effects of
overhydration*

40. Hypervolemia

41. Effects of Hypervolemia

42. Hypervolemia
 Treatment
 Limit fluidintake
 In more serious cases, diuretics may
be prescribed to increase urination
 Identifying and treating any
underlying condition (such as
impaired heart or kidney function) is a
priority

43. Hypervolemia
 NOTE:
 The best advice is to drink when you are thirsty and
to aim to drink 6-8 glasses, 2-3 litres per day;
 *Consider the differences in physical
activity, climate and diet
 *Less fluid intake for lower intensity exercise in
milder conditions and more for superior athletes
competing at higher intensities in warmer
environments

44. Hypervolemia
• The best guidance is
for individuals to
remain adequately
hydrated, but not
overhydrated

45. Calculate your water needs:

46. Water Homeostasis

47.  The average adult body
contains 40 liters of H2O.
This amount, called total
body water, remains
fairly constant under
normal circumstances.

48. Maintenance of Water Homeostasis
 It is a balancing act
because the amount
of water taken in must
equal the amount of
water lost.

49. Disturbance of Water Homeostasis
 Two categories
 Gain or loss of
Extracellular fluid
volume
 Gain or loss of solute
 In many instances
disturbances of water
and homeostasis involve
imbalances of both
volume and solute.

50. Mechanism of Fluid Balance
 Antidiuretic Hormone
 Thirst mechanism
 Aldosterone
 Sympathetic Nervous System

51. Effect of ADH

52. Thirst mechanism
 The prime regulator of water intake and involves
hormonal and neural input as well as voluntary
behaviors.

56. WATER AND ELECTROLYTE
BALANCE & BODY FLUIDS

57. Electrolytes
 Cations
 Anions
 Electrolytes are not evenlydistributed within the
body, and their uneven distribution allows many
important metabolic reactions to occur

58. Purpose of Electrolytes
 Help control water balance and fluid distribution
in the body
 Create an electrical gradient across cell
membranes that is necessary for muscle
contraction and nerve transmission
 Regulate the acidity (pH) of the blood
 Help regulate the level of oxygen in the blood
 Are involved in moving nutrients into cells and
waste products out of cells

59. Specific Function
 Sodium- affects how much urine the kidney
produces and is involved in the transmission of
nerve impulses and muscle contraction
 Potassium- regulate fluid balance in cells, the
transmission of nerve impulses, and in muscle
contractions
 Calcium-build and maintain bones. It also plays a
role in nerve impulse transmission and muscle
contraction.

60. Specific Function
 Magnesium- involved in protein synthesis and
cellular metabolism
 Chloride- involved in regulating blood pressure
 Phosphate- helps control the acidity level (pH) of
the blood; also causes calcium to be deposited in
bones

61. Electrolyte Balance

62. Body Secretions

63. Gastrointestinal Secretions

64. Saliva (Composition)
 Inorganic composition  dependent on stimulus and rate of salivary
flow
 Major components are Na+, K+, HCO3-, Ca++, Mg++, and Cl-.
 [] of ions varies with the rate of secretion  which is stimulated during the
postprandial period.
 Organic constituents  synthesized, stored, and secreted by the
acinar cells
 Major products are amylase, lipase, glycoprotein (mucin, which forms mucus
when hydrated), and lysozyme (attacks bacterial cell walls to limit
colonization of bacteria in the mouth)

65. Saliva (Enzyme Content)
 2 major types of protein secretion:
 Serous secretion  contains ptyalin, an amylase
enzyme for digesting starches and cleansing agent for
the oral cavity
 *Saliva has a pH between 6.0 and 7.0 (favorable range
for the digestive action of ptyalin)
 Mucus secretion  contains mucin for lubricating and
for surface protective purposes

66. Saliva (Enzyme Content)
 Parotid glands - serous type of secretion
 Submandibular and Sublingual glands - both serous
secretion and mucus
 Buccal glands - secrete only mucus
 *Aside from amylase, saliva has presence of other enzymes
such as maltase, catalase, lipase, urease, and protease.

67. Saliva (Control Mechanism)

68. Saliva (Control Mechanism)
 Salivary glands  controlled mainly by
parasympathetic nervous signals, from the superior
and inferior salivatory nuclei in the brain stem
 Salivatory nuclei  excited by both taste and tactile
stimuli from the tongue, mouth and pharynx
 *  salivation  taste stimuli, especially sour taste
(caused by acids), tactile stimuli, such as the presence
of smooth objects in the mouth

69. Saliva (Control Mechanism)
 Salivation can be stimulated or inhibited by
nervous signals arriving in the salivatory nuclei
from CNS
 Appetite area of the brain  located in proximity
to the parasympathetic centers of the anterior
hypothalamus, functions to in response to signals
from the taste and smell areas of the cerebral
cortex or amygdala.

70. Saliva (Control Mechanism)
 Saliva  helps remove the irritating factor in the GIT
(diluting or neutralizing the irritant substances)
 Sympathetic nerves  from Superior cervical ganglia
 Salivary glands (slight increase in salivation)
 2 factor - blood supply to the glands (nutrition)
 Parasympathetic nerve signals  copious salivation 
moderately dilate the blood vessels  increased
salivatory gland nutrition

71. Saliva (Functions)
 Digestive function (enzymes)
 Moistens and lubricates food  swallowed easily
 Holds the taste-producing substances  brings in
contact with the taste buds
 Dilutes salts, acids  protecting the mucosa
(teeth)

72. Saliva (Function on Oral Hygiene)
 Under basal awake conditions  about 0.5 ml/ min of saliva (mucous
type)
 *During sleep, secretion becomes very little.
 Saliva helps prevent deteriorative processes in several ways:
1. Wash away pathogenic bacteria and food particles that provide their
metabolic support
2. Contains thiocyanate ions and lysozyme
3. Contains protein antibodies that can destroy oral bacteria, including
some that cause dental caries
 *In the absence of salivation, oral tissues  often become ulcerated
and infected  caries of the teeth can become rampant.

73. Saliva (Tests)
 Saliva is easy to access and collection is non-invasive
 Used to identify individuals with disease (presence of biomarkers) and
to monitor progress under treatment
 Viral infections such as human immunodeficiency virus
(HIV), herpes, hepatitis C, and Epstein-Barr virus infection 
polymerase chain reaction (PCR) techniques
 Bacterial infections, such as Helicobacter pylori, can likewise be
detected in saliva
 Monitoring drugs levels

74. Saliva (Clinical Disorders)
 *Abnormal production of the salivary glands can cause
serious complications & adverse effects to salivary
functions.
 Xerostomia (dry mouth) is caused by impaired salivary
secretion
 Congenital or develop as part of an autoimmune process
 Decrease in secretion  reduces pH in the oral cavity 
tooth decay and is associated with esophageal erosions 
difficulty swallowing.

75. Gastric Juice
 Stomach mucosa has two important types of tubular glands: (1)
oxyntic glands (gastric glands) and (2) pyloric glands.
 Oxyntic (acid-forming) glands - secrete HCL, pepsinogen,
intrinsic factor, and mucus
 3 types of cells: (1) mucous neck cells (mucus); (2) peptic or chief
cells (pepsinogen); and (3) parietal or oxyntic cells (hydrochloric
acid and intrinsic factor)
 Pyloric glands - secrete mainly mucus (protection of the pyloric
mucosa from the stomach acid) and hormone gastrin.

76. Composition: Inorganic Constituents
  Secretory rate  Higher the concentration of ions
 [K+] is always higher in gastric juice than in plasma
(prolonged vomiting may lead to hypokalemia).
 At high rates of secretion, gastric juice resembles an
isotonic solution of HCl
 Gastric HCl converts pepsinogens to active pepsins and
provides the acid pH at which pepsins are active

77. Composition: Inorganic Constituents
 Rate of gastric H+ secretion varies considerably among
individuals
 Basal (unstimulated) rates of gastric H+ production  1 to 5
mEq/hr
 During maximal stimulation, HCl production  from 6 to 40
mEq/hr
 Total number of parietal cells in the stomach  partly
responsible for the wide range in basal and stimulated rates
of HCl secretion.

78. Gastric Juice
Composition: Organic Constituents
 Pepsin  proteases secreted by the chief cells, active at pH 3
& below
Pepsinogen  the inactive proenzyme of pepsin
 Pepsinogens
- contained in membrane-bound zymogen granules in
the chief cells
- converted to active pepsins by the cleavage of acid-
labile linkages (the lower the pH, the more rapid the conversion)

79. Gastric Juice
Enzyme Content
Pepsin
 Pepsinogen - no digestive activity, activated to pepsin when comes
in contact with HCL
 Pepsin - proteolytic enzyme (optimum pH 1.8 to 3.5), above pH 5 
almost no proteolytic activity (inactivated)
 Major products of pepsin action  large peptide fragments and
some free amino acids
 Gastric protein digestion  important in peptides and amino acids
generation  stimulants for cholecystokinin release in the duodenum
* Gastric peptides are therefore instrumental in the initiation of the
pancreatic phase of protein digestion

80. Gastric Juice
Enzyme Content
Gastric Lipase
 Initiating the digestion of lipids in the stomach.
 Converts triacylglycerols into fatty acids and diacylglycerols
 Initial hydrolysis  important since some of the water-immiscible
triacylglycerols are converted to products with both polar and non-
polar groups (stable interface with the aqueous environment)

81. Gastric Juice
Control Mechanism: SECRETION
Gastric secretion occur in three phases: (1) cephalic phase, (2) gastric
phase, and (3) intestinal phase

82. Gastric Juice
Control Mechanism
Cephalic phase
 Occurs even before food enters the stomach, especially while it is
being eaten
 Results from the sight, smell, thought, or taste of food, and the
greater the appetite, the more intense is the stimulation
 Neurogenic signals originate in the cerebral cortex and appetite
centers of the amygdala and hypothalamus  transmitted through the
dorsal motor nuclei of the vagus  vagus nerves to the stomach

83. Gastric Juice
Control Mechanism
Gastric phase
 Once food enters the stomach  excites the long vagovagal reflexes
from the stomach to the brain and back to the stomach  local enteric
reflexes  gastrin mechanism  cause secretion of gastric juice
during several hours while food remains in the stomach
 Accounts for about 70 per cent of the total gastric secretion
associated with eating a meal (1500 ml).

84. Gastric Juice
Control Mechanism
Intestinal phase
Presence of food in the upper portion of the small intestine
(duodenum)  cause stomach secretion of small amounts of gastric
juice (partly because of small amounts of gastrin released by the
duodenal mucosa)

85. Gastric Juice
Control Mechanism: INHIBITION
 Affected by other post-stomach intestinal factors
 Presence of food in the small intestine  reverse enterogastric
reflex  transmitted through the myenteric nervous
system, extrinsic sympathetic and vagus nerves  inhibits
stomach secretion
 Can be initiated: distending the small bowel, presence of acid
(upper intestine), presence of protein breakdown products, or by
irritation of the mucosa
 This is part of the complex mechanism for slowing stomach
emptying when the intestines are already filled.

86. Gastric Juice
Control Mechanism: INHIBITION
 Release of several intestinal hormones
 Secretin - important for control of pancreatic secretion but
opposes stomach secretion
 Gastric inhibitory peptide, vasoactive intestinal polypeptide, and
somatostatin - slight to moderate effects in inhibiting gastric
secretion
 Functional purpose of inhibitory gastric secretion: to slow passage
of chyme from the stomach when the small intestine is already filled
or already overactive
 Enterogastric inhibitory reflexes plus inhibitory hormones also
reduce stomach motility at the same time that they reduce gastric
secretion

87. Gastric Juice
Functions
 Gastric juice is characterized by the presence of hydrochloric acid
and therefore a low pH less than 2 as well as the presence of proteases
of the pepsin family
 Acid serves to kill off microorganisms and also to denature proteins
*Denaturation makes proteins more susceptible to hydrolysis by
proteases
 Serves in the initial hydrolysis of lipids with the help of gastric
lipase enzyme

88. Gastric Juice
Tests
 Qualitative tests include those for butyric acid, lactic acid, occult
blood, bile and trypsin.
 Presence of the first two acids  yeast or other microorganisms
in the gastric secretions  lack of hydrochloric acid
 If blood is present  ulcers, hemorrhages and other pathologic
states
 Either bile or trypsin  evidence of regurgitation of intestinal
contents
 Quantitative procedures  total acidity contributed by HCL, organic
acids and acid salts, neutralized or buffered by various constituents of
the gastric juice and food

89. Gastric Juice
Clinical Disorders
 Achlorhydia - absence of hydrochloric acid (pernicious anemia, gastric
carcinoma)
 Hypoacidity - if HCL is not entirely absent but below normal
(pregnancy, gastric carcinoma, gastritis and constipation, secondary
anemia, and chronic debilitative diseases)
 Hyperacidity - acidity is elevated (duodenal ulcer and gallbladder
disease)
*It should be emphasized that the acidity cannot exceed a certain value
(pH 0.87) since the parietal cells secrete a fluid of constant composition

90. Pancreas

91. Pancreatic Juice
 The pancreas, parallel to and beneath the stomach, is a large
compound gland similar to the internal structure of salivary glands
 Exocrine secretion: combined product of enzymes and sodium
bicarbonate secretions  flows through a long pancreatic duct  joins
the hepatic duct  empties into the duodenum through the papilla of
Vater, surrounded by the sphincter of Oddi.
 The pancreas also secretes insulin (not secreted by the same
pancreatic tissue secreting pancreatic juice)
 Insulin is secreted directly into the blood—not into the intestine—by
the islets of Langerhans that occur in islet patches throughout the
pancreas

92. Pancreatic Juice
Composition
 Alkaline in nature with a pH of about 8.
 Large volumes of sodium bicarbonate solution are secreted by the
small ductules and larger ducts leading from the acini
 Bicarbonate ions play an important role in neutralizing the acidity of
the chyme emptied from the stomach into the duodenum.
 The pancreatic digestive enzymes are secreted by pancreatic acini

93. Pancreatic Juice
Enzyme Content
 Pancreatic secretion contains multiple enzymes for digesting all of the
three major types of food: proteins, carbohydrates, and fats
Proteins:
 Trypsin and chymotrypsin  split whole and partially digested
proteins into peptides of various sizes (do not cause release of individual
amino acids)
 Carboxypolypeptidase  split some peptides into individual amino
acids  completing digestion of some proteins all the way to the amino
acid state

94. Pancreatic Juice
Enzyme Content
 Proteolytic digestive enzymes - inactive forms first:
trypsinogen, chymotrypsinogen, and procarboxypolypeptidase
 Activated after secreted into the intestinal tract
 Trypsinogen  activated by an enzyme called enterokinase (secreted
by the intestinal mucosa when chyme comes in contact with it) or by
previously activated trypsin
 Chymotrypsinogen and Procarboxypolypeptidase  activated by
trypsin to form chymotrypsin and carboxypolypeptidase

95. Pancreatic Juice
Enzyme Content
Carbohydrates:
 Pancreatic amylase  which hydrolyzes starches, glycogen, and most
other carbohydrates (except cellulose)  form mostly disaccharides and
a few trisaccharides
Fat:
 Pancreatic lipase  hydrolyzing neutral fat into fatty acids and
monoglycerides
 Cholesterol esterase  hydrolysis of cholesterol esters
 Phospholipase  splits fatty acids from phospholipids

96. Pancreatic Juice
Control Mechanism
3 Basic stimuli for pancreatic secretion
 Acetylcholine  released from the parasympathetic vagus nerve
endings and from other cholinergic nerves in the enteric nervous system
 Cholecystokinin  secreted by the duodenal and upper jejunal
mucosa when food enters the small intestine
 Secretin  secreted by the duodenal and jejunal mucosa when
highly acid food enters the small intestine

97. Pancreatic Juice
Control Mechanism
 Acetylcholine and cholecystokinin  stimulate the acinar cells of the
pancreas  production of large quantities of pancreatic digestive
enzymes (relatively small quantities of water and electrolytes)
*Without water, most of the enzymes remain temporarily stored in the
acini and ducts until more fluid secretion comes along to wash them into
the duodenum
 Secretin  stimulates secretion of large quantities of water solution
of sodium bicarbonate by the pancreatic ductal epithelium

98. Regulation of Pancreatic Secretion

99. Pancreatic Juice
Control Mechanism
Pancreatic secretion occurs in three phases: (1) cephalic phase, (2)
gastric phase and (3)intestinal phase
Cephalic phase  same nervous signals from the brain that cause
secretion in the stomach  cause acetylcholine release by the vagal
nerve endings in the pancreas  causes moderate amounts of enzymes
to be secreted into the pancreatic acini
*Accounting for about 20 per cent of the total secretion of pancreatic
enzymes after a meal

100. Pancreatic Juice
Functions
 Secretions from pancreas  quantitatively the largest contributors to
enzymatic digestion of food
 Provides additional important secretory products that are vital for
normal digestive function including
 Water and bicarbonate ions  neutralizing gastric acid so that the
small intestinal lumen has a pH approaching 7.0.  reduces injury to
small intestinal mucosa by such acid acting in combination with pepsin
*Pancreatic enzymes are inactivated by high levels of acidity

101. Pancreatic Juice
Tests
 The fact that secretin stimulates the flow of pancreatic juice has been
made use as a test of external pancreatic functions
 Double-lumen tube  passed (longer end reaches the third portion of
the duodenum and the shorter end remains in the stomach) 
continuous aspiration (-20 to 30 mmHg) prevents the overflow of gastric
juice into the duodenum and sucks out both gastric juice and duodenal
contents into separate containers  secretin is injected intravenously
after a basal flow has been obtained  volume of flow and bicarbonate
concentration is measured

102. Pancreatic Juice
Tests
 Outpouring of pancreatic juice
 Under normal conditions, duodenal fluid  lose its biliary color
 If the bile color remains  a non-functioning gallbladder is
indicated
 The total volume varies normally from 135 to 250 ml in 1 hour,
and the bicarbonate, from 90 to 130 mEq
*In pancreatitis with extensive destruction of parenchymal structures,
there is usually a diminution in the volume of pancreatic juice and
bicarbonate output

103. Pancreatic Juice
Clinical DIsorders
 Damaged pancreas/ ducts blocked  large quantities of pancreatic
secretion become pooled in the damaged areas
 Pancreatitis  enzymes secreted by pancreatic acinar cells become
proteolytically activated before reaching appropriate site of action (small
intestinal lumen)
 Pancreatic juice contains trypsin inhibitors  reduce the risk of
premature activation
 Trypsin can itself be degraded by other trypsin molecules
*Specific mutation in trypsin  renders it resistant to degradation by
other trypsin molecules.

104. Pancreatic Juice
Clinical DIsorders
 Pancreas reacts very sensitively to an impairment of the protein
metabolism
 Decreased supply of proteins leads  impairment of the
endogenous stimulation of pancreas  atrophy of acinous cells
and fibrosis of pancreas (e.g. long-term fasting)
Decreased contents of pancreatic enzymes
 Decreased secretion of their proenzymes, insufficient intraluminal
activation or inactivation of enzymes
*Celiac sprue  secretions of lipase and trypsinogen are decreased 
trypsin deficiency  deficiency of chymotrypsin and other enzymes
which are activated from proenzymes by trypsin

105. BILE
 An alkaline, brownish-
yellow or greenish-yellow
fluid that is secreted by the
liver, stored in the
gallbladder, and discharged
into the duodenum and aids
in the
emulsification, digestion, an
d absorption of fats.

106. Bile Composition
 Water (85%),
 bile salts
(10%),(Cholic, chenodeoxycholic, deoxycholi
c, and lithocholic acid)
 mucus
• pigments (3%), bile pigments e.g bilirubin
glucuronide
• fats (1%), such as Phospholipids (lecithin)
, cholesterol
• 0.7% inorganic salts

107. Bile Composition
 In concentrating process in gallbladder, water and
large portions of electrolytes are reabsorbed by
gallbladder mucosa
 Bile salts and lipid substances cholesterol and
lecithin, are not reabsorbed
 The concentrated bile is composed of bile salts,
cholesterol, lecithin, and bilirubin.

108. Bile Pigments
 Bilirubin and Biliverdin*
Urobilin Urobilinogen Bilirubin Biliverdin
(Brown) (colorless) (red) (green)

109. Bile Secretion
Release of hormone
Bile is subsequently
secretin and CCK
stored & concentrated in
(chocystokinin) from the
the gallbladder between
duodenum increase bile
meals
secretion
Bile is normally stored in
gallbladder until needed
in duodenum*

110. Bile Secretion
 After meal, bile enters the duodenum as a result
of combined effects of :
 Gall bladder emptying
 Increased bile secretion by liver
 The amount of bile secreted per day ranges from
250 ml to 1 litre

111. Emptying of Gallbladder
Gallbladder begins to
empty, when food (fatty Gallbladder emptying is
foods) reach the rhythmical contractions of
duodenum about 30 the gallbladder*
minutes after a meal*
Effective emptying
requires simultaneous
relaxation of sphincter of
oddi*

113. Bladder bile vs. Liver bile bile (%)
Constituent Bladder bile (%) Liver
Water 82.3-89.8 96.5-97.5
Solids 10.2-17.7 2.5-3.5
Bile Salts 5.7-10.8 0.9-1.8
Mucus and Pigments 1.5-3.0 0.4-0.5
Cholesterol and other 0.5-4.7 0.2-0.4
lipids
Inorganic Salts 0.6-1.1 0.7-0.8

114. ENTEROHEPATIC CIRCULATION
 About 95% of the salts
secreted in bile are
reabsorbed actively in the
terminal ileum and re-used.
Blood from the ileum flows
directly to the hepatic
portal vein and returns to
the liver where the
hepatocytes reabsorb the
salts and return them to the
bile ducts to be re-
used, sometimes two to
three times with each meal.

115. Function of Bile Juice*
 Bile acts as a surfactant , helping to emulsify the
fats in the food.
 Bile salt anions have a hydrophilic side and a
hydrophobic side, and therefore tend to aggregate
around droplets of fat ( triglycerides and
phosphiolipids ) to form micelles.
 The hydrophilic sides are positively charged due to
the lecithin and other phospholipids that compose
bile, and this charge prevents fat droplets coated
with bile from re-aggregating into larger fat particles.
 Fat in micelles* form provide a large surface area for
the action of the enzyme pancreatic lipase in the
digestion of lipids.

116. Bile Juice

117. Function of Bile Juice
 The alkaline bile has the function of neutralizing
any excess stomach acid before it enters the
ileum.
 Bile salts also act as bactericides, destroying many
of the microbes that may be present in the food.

118. Preventing Metabolic Deficit
 Without the presence of bile salts in the intestinal
tract, up to 40 percent of the ingested fats are lost
into the feces, and the person often develops a
metabolic deficit because of this nutrient loss.

119. Abnormalities associated with bile
 Gall stone- majority of gall
stones are made up of
cholesterol , (cholesterol
tends to accrete into lumps
in the gallbladder)
 Causes of gall stones;
 - Too much absorbtion of
water from the bile .
 - Too much cholesterol in
bile.
 - Inflammation of the
epithelium.

120. Small intestine juice
 small intestine is where most chemical digestionand fluid
absorption takes place
 Water and lipids are absorbed by passive diffusion throughout
the small intestine.
 Sodium Bicarbonate is absorbed by active transport and
glucose and amino acid co-transport
 Fructose is absorbed by facilitated diffusion

121. Intestinal Juice
 Intestinal juice is not as
definite an entity as
pancreatic juice or gastric
juice because it varies at
different levels of intestinal
tract*
 Succus entericus is
influenced by the hormone
secretin
 Enterocrinin* stimulates
mucosal glands

122. Intestinal Juice*
leukocytes Epithelial cells Mucus
Organic material
1.5% Solid
8.3 pH* eg. mucoproteins
components*
and enzyme*

123. Feces Formation and Composition
Feces is the waste material
passed out from the bowels
through the anus.
 It is usually solid to semi-
solid in consistency but can
be hard in constipation or
watery with diarrhea

124. Feces Formation
 Large amounts of water and electrolytes are
absorbed in the first half of colon.*
 Water absorption transforms the fluid chyme into
a mush-like consistency by the time it passes
through the transverse colon.
 It solidifies further along its passage down the
descending colon.

125. Composition of Feces
 About 75% of fecal weight is made up of water.
 The other 25% is composed of solid matter which
contains :
 Undigested fiber and solidified components of
digestive juices (30%)
 Bacteria (30%)
 Fat (10% to 20%)
 Inorganic matter (10% to 20%)
 Protein (2% to 3%)

126. Water and Electrolytes in the Colon
 Electrolytes(bicarbonate) are secreted by the wall
of the large intestine into the lumen to neutralize
any acidic byproducts of bacterial metabolism.
 Sodium and chloride are absorbed by the
intestinal wall which creates a concentration
gradient to facilitate water absorption.

127. Feces
 *Any extra fluid remain in the colon give a liquid
consistency to the feces (loose stool).
 It also increases defecation frequency by
triggering the local defecation reflex.

128. Feces
 The Bristol Stool Chartor Bristol Stool Scale is a
medical aid designed to classify the form of
human feces into seven categories
The form of the stool depends on the time it
spends in the colon.

129. Color of feces
 Feces usually has a brown color, ranging from a
tan hue to a darker-brown color.
 Bilirubin is passed out in the bile and the action
of bacteria and air in the gut breaks it down into
stercobilin and urobilin, which gives stool its
typical color.

130. Smell of Feces
 Odor
- H2S (rotten egg smell)
- mercaptans (sewer gas)

132. Characteristics
Characteristics of urine under physiological conditions
Characteristic Normal Quantity or Quality
Volume 115 to 180 L /day (women)
130 t0 200 L / day (men)
Color Amber
Odor Not unpleasant (aromatic)
Turbidity Clear and transparent
pH 4.6 to 8.0

133.  Color  Odor
 Amber  Does not have unpleasant
 Pigment: urochrome smell (aromatic)
 Other pigments:  Other odors arise from food
uroerythrin, uroporphyrins,  Mercaptan-like odor after
riboflavin eating asparagus
 Oil of wintergreen (has
methyl salicylate)  strong
odor of evergreens

134.  Turbidity  pH
 Urine is clear and  Varies from 4.6 to 8.0
transparent  Protein diet gives rise to
 After standing for a long acidic pH  oxidation of
sulfur in sulfur containing
time  flocculent material amino acids into sulfuric
(mucoprotein + acid
nucleoprotein + epithelial  Vegetable and fruit diet
cells) separates gives rise to alkaline urine
 Urine samples taken right
after eating meals are
alklalinesecretion of H+ in
the gastric juice

135. Ions in the urine
 Anions  Cations
 The major anion is chloride  Sodium and potassium are
 The amount is equal to the the major cations
amount that was ingested  Total excretion of Na+ varies
 In salt-poor diets, Cl- may be between 2.0 and 4.0 g/day
absent  K+ 1.5 to 2.0 g/day.

136.  Nitrogenous organic
compounds Component Amount
 Urea α the total nitrogen Urea 12 to 36 g per
intake day (70-g
 Uric acid – end product of adult)
purine metabolism; α purine Uric acid 0.7 g of uric
intake acid per day
 Creatinine α muscle mass
Creatinine 18 to 32 and
 Creatine predominant in (coefficient) 10 to 25 in
children and pregnant women
women
Hippuric acid 0.7 g per day
 Hippuric acid - formed in the
liver Indican 5 to 25 mg per
 Indican – potassium salt day

137. Composition
Normal concentration of organic compounds, anions, and cations in urine
Component Concentration in Concentration in [U]/[P]*
urine (mg percent) blood (mg percent)
Urea 2000 30 67
Uric acid 60 2 30
Creatinine 75 2 37
Indican 1 0.05 20
Phosphate 150 3 50
Sulfate 150 3 50
Potassium 150 20 7.5
Chloride 500 350 1.4
Sodium 350 335 1
Calcium 15 10 1.5
* Concentration in urine / concentration in blood plasma

138. Glycosuria
 The normal glucose range is 10 to 20 mg per 100
mL or urine
 High amounts of sugars lead to glycosuria
 Glucosuria
 Pentosuria
 Lactosuria
 Galactosuria
 Fructosuria

139.  Pentosuria  Tests for pentosuria
 Occurs after eating unusual  Benzidine + acetic acid +
amounts of fruits and fruit urine  mixture is heated
juices then cooled  rose-pink
 Idiopathic pentosuria – color (+ for pentose)
occurs in the absence of L-  (+) Benedict’s reagent
xylulose dehydrogenase (a  (-) baker’s yeast
genetic disease) fermentation
 Xylulose is excreted in the
urine

140.  Lactosuria  Tests for lactosuria
 Moderate amounts of  (+) baker’s yeast
lactose secretion is found in fermentation
lactating women  (+) mucic acid test
 Does not occur in pregnancy
 (-) Barfoed’s test
 Yields lactosazone

141.  Fructosuria  Tests for fructosuria
 Occurs in association with  (+) Benedict’s reagent
diabetes mellitus  (+) baker’s yeast
 The site of difficulty is the fermentation
liver (it’s where fructose is  Yields glucosazone and
stored as glycogen phenylhydrazine
 There is a deficiency in the
enzyme fructokinase

142.  Galactosuria  Tests for galactosuria
 A consequence of  reduction of alkaline copper
galactosemia solutions
 Galactose is not detectable  slight fermentation by
in the urine prior to the baker’s yeast
introduction of milk in the  (+) Barfoed’s test
diet  (+) mucic acid test.

143.  Proteinuria  Tests for Proteinuria
 presence of proteins, most  Nitric acid ring test
especially albumin, in the  Sulfosalicylic acid test –
urine. degree of turbidity (+)
 Plasma proteins may pass  Heat and acetic acid test –
damaged renal epithelium ring of white turbidity (+)

144.  Lipuria
 presence of large amounts of
fat in the urine
 Urine is opalescent, turbid, or
milky when voided
 The high blood fat (lipemia)
that sometimes occurs in
diabetes mellitus and lipoid
nephrosis may lead to lipuria.
 Also in patients with fractures
of the long bones with injury
to the bone marrow

145. Lymph
Body Fluid

146.  The lymphatic system maintains volume
and pressure of the extracellular fluid
 returns excess water and dissolved substances
from the interstitial fluid to the circulation
 Lymph is the fluid that is present in the
lymphatic capillaries that drain the
interstitial spaces.

147. Mechanism of lymph flow
 Travels down the pressure
gradient.
 Muscular and respiratory
pumps push the lymph
forward via the action of
semilunar valves.
 blood capillaries 
interstitial fluid  lymph
capillaries  lymphatic
veins  lymph nodes 
lymph ducts and finally 
brachiocephalic veins and
vena cavae.

148. Composition
 Lymph has a similar composition to blood
plasma.
 The only difference is that it contains lower
percentage of protein than blood plasma.
 Lymph albumin:globulin ratio > plasma
albumin:globulin ratio
 Albumin is smaller than globulin  it diffuses
from plasma to lymph more readily than the
latter.
 Fibrinogen, prothrombin, and leukocytes are
present in lymph, too.

149.  The composition of lymph varies with the
state of digestion.
 After a meal, the fat content rises since more than
half the fat absorbed goes by this route. The lymph
becomes milky if the food contains much fat.
 Lymph has the same composition as the ISF
 Asit flows through the lymph nodes it comes
in contact with blood, and tends to
accumulate more cells
(particularly, lymphocytes) and proteins.

150.  Anedema that is caused by
the blockage of lymph
return

151. Cerebrospinal fluid
Body Fluids

152. CSF functions in
 protecting the brain from sudden
changes in pressures.
 Maintaining a stable environment
 removing waste products of the cerebral
hemisphere.

153. Production of CSF
choroid plexus P P
subarachnoid
in the cisternae
space
ventricles
arachnoid villi venous blood

154. Characteristics of CSF under physiological conditions
Characteristic Normal Quantity or
Quality
Volume 20 mL per day
Color Colorless
Specific gravity 1.004 to 1.008
Turbidity Clear
pH 7.35 to 7.40

155. Component Concentration or ratio in CSF
Glucose <4.5 mmol/L
Lactate <2.1 mmol/L
Proteins 0.15 to 0.45 g/L
IgG (blood to CSF 500:1
ratio)
IgG index 0.66

156. CSF Pathology
 Spinal cord disorders (compressive syndrome)
 Hemorrhage
 Infections (meningitis, encephalitis, myelitis)
 Inflammatory autoimmune diseases (multiple
sclerosis, Guillain-Barré syndrome)
 Systemic autoimmune diseases (vasculitis, systemic lupus
erythematosus)
 Malignancy
 Degenerative processes (Alzheimer’s
syndrome, amyotrophic lateral sclerosis, Parkinson’s
disease)
 Demyelinating disease

157.  CSF is collected using lumbar puncture. The
appearance and pressure of CSF are evaluated to
know what kind of pathology is present in an
individual.

158. Lange’s colloidal
gold test
 Done by mixing
decreasing dilutions of
CSF with colloidal gold
solution
 Normal CSF causes no
change in the appearance
of the orange-red colored • Paretic curve
solution • Fluids with large globulin
 Fluids with pathologic content
conditions produce color • Such curves are contained in
change depending on the casese with general paralysis
condition and dilutiona • Multiple sclerosis, lead
poisoning with brain
involvement

159.  Luetic curve • Meningitic curve
 Fluids with limited globulin • Large amounts of globulin and
and moderate albumin content globulin
 Certain forms of cerebro-spinal • All meningitic conditions show
syphilis this kind of curve
 Also in brain
tumor, poliomyelitis, and
cerebral arteriosclerosis

160. Sperm & Semen (Contents)
 Fructose – this serves as the primary nutrient source
of the sperm cells.
 Citric Acid – no definite function for the sperm. But is a
basis for diagnosing acute and chronic prostatitis
 Fibrinogen – forms a clot when the semen is
introduced to the reproductive tract, forms a clot for
15 mins then disintegrates to promote sperm motility.

161.  Prostaglandins – makes the female reproductive
tract more receptive to sperm movement and
possibly causes backward, reverse peristaltic
movement to propel the sperm towards the
ovaries. (A sperm cell can reach the upper ends of
the fallopian tube within 5 minutes)
 Profibrinolysin – is changed to fibrinolysin to
dissolve the clot formed by the fibrinogen
 Calcium ion – enters the sperm when it is within
the female reproductive tract thus giving the
sperm a whiplash motion.

162. Contained in the acrosome
 Hyaluronidase – depolymerizes the hyaluronic
acid polymers in the intercellular cement that
holds the ovarian granulosa cells together.
 Proteolytic enzymes – digest proteins in the
structural elements of tissue cells that still adhere
to the ovum

164.  The Prostate glands secretes a thin milky fluid that
contains calcium, citrate ion, phosphate ion, a
clotting enzyme and profibrinolysin.
 Alkalinic pH is to combat the Acidic pH of the
vagina (pH of 3.5 to 4.0). The sperm becomes
motile when the pH rises to about 6.0 to 6.5.

165. Control Mechanism
 Spermatogenesis
 Testosterone, secreted by the Leydig cells,
essential for growth and division of the testicular
germinal cells, first stage in forming sperm cells.
 Luteinizing hormone, stimulate the Leydig cells to
release testosterone

166. Control Mechanism
 Follicle-stimulating hormone, stimulates the
Sertoli cells; without this stimulation, the
conversion of the spermatids to sperm will not
occur.
 Estrogens, essential for spermiogenesis
 Growth hormone, promotes early division of the
spermatogonia

167. Diagnostic Procedures
 Semen Allergy Test - Women with seminal plasma
protein allergy (SPPA) have an immunologic
response to human semen. The immunological
mechanism of semen allergy is a type I
hypersensitivity reactions.

168.  Semen Analysis - A low sperm count is diagnosed
as part of a semen analysis test. Sperm count is
generally determined by examining semen under
a microscope to see how many sperm appear
within squares on a grid pattern. In some cases, a
computer may be used to measure sperm count.

170.  Semen analysis results
Normal sperm densities range from 20 million to
greater than 100 million sperm per milliliter of
semen. You are considered to have a low sperm
count if you have fewer than 20 million sperm per
milliliter. Some men have no sperm in their semen
at all. This is known as azoospermia

171. Transudate and Exudate
(Introduction)
 There are various places in the body where fluids
can accumulate. When fluids accumulate inside a
cavity they are referred to as effusions. Effusions
can occur in the pleural, pericardial, and
peritoneal cavities of the body.

172. Transudate
 A transudate is a fluid that accumulates in cavities
due to a malfunction of the filtering membranes
of cavity linings.
 The fluid balance between the linings to become
disrupted, which in turn leads to the buildup of
fluid on one side of the membrane.

173. Exudate
 An exudate is a fluid that accumulates inside a
cavity due to the presence of foreign materials
such as bacteria, viruses, parasites, fungi, and
tumor cells.

174.  An exudate forms as a result of all these cells
(both leukocytes and foreign material) and their
metabolites filling the cavity.

175. How to differentiate transudate
from exudate
 The major test used to differentiate between a
transudate or an exudate is the concentration of
total protein in a fluid. Transudates generally have
total protein concentration less than 3.0 g/dL
while exudates generally have a total protein
greater than 3.0 g/dL.

176. Rivalta Test
 Rivalta test is used in order to differentiate
a transudate from an exudate. A test tube is filled
with distilled water and acetic acid is added. To
this mixture one drop of the effusion to be tested
is added. If the drop dissipates, the test is
negative, indicating a transudate. If the drop
precipitate, the test is positive, indicating an
exudate.

178. Composition, Enzyme Content,
Diagnostic Procedures:
 Lactate dehydrogenase
 Lactate dehydrogenase is an enzyme that is used
by cells in metabolism and production of energy.
When there is a large presence of cells and cell
death such as in infection and inflammation the
concentration of LDH in the area increases.
 Transudates will have LDH levels lower than 200
units/L while exudates will have LDH levels higher
than 200 units/L.

179.  Glucose and Amylase
 Decreased values in the concentration of glucose
in an exudate can occur in bacterial
infections, malignancies, rheumatoid arthritis, and
tuberculosis.
 Concentrations of amylase can accumulate in an
exudate in response to esophageal
rupture, pancreatitis, and pancreatic cancer. No
matter what chemistry testing is ordered on a
fluid it is best to compare it in relation to serum
levels to help assess whether a fluid is a
transudate or an exudate

180.  Leukocytes
 Transudates are generally clear and pale yellow in
appearance as they are basically filtrates of
plasma.
 These fluids contain very little cellular material.
The leukocyte count is usually less than 1.0 X
109/L and the erythrocyte count is less than 100.0
X 109/L.
 The leukocytes that are present consist of
monocytes and lymphocytes.

181.  Exudates will generally appear cloudy or turbid.
 May appear yellow, brown, greenish, and even
bloody.
 In some instances they may even be clotted due
to the presence of fibrinogen
 The leukocyte count will usually be greater than
1.0 X 109/L and include
neutrophils, lymphocytes, monocytes, eosinophils
, and even basophils.

183. Synovial Fluid

184. Composition
 Mucopolysaccaride
 0.9% hyaluronic acid – most important. Functions
in lubricating the joints
 Albumin
 Globulin
 Glucose
 Lipids
 Nonprotein nitrogenous substances

185. Enzyme content
 Alkaline phosphatase
 Acid phosphatase
 Lactic dehydrogenase

186. Function
 Supply nutrients to cartilage
 Act as lubricant to joint surfaces
 Carry away waste products

187.  String Test- viscosity and clarity of the fluid can be examined.
Tests
Viscosity Clarity
Normal Fluid When dropped from a Transparent & colorless-
syringe, forms a string of light yellow
greater than 10-15cm
Inflammatory Fluid Low viscosity & flows like Cloudy & yellow/green
H20
Non-inflammatory Fluid Clear & yellow
Haemorrhagic fluid Cloudy & red/
red-brown
*Normal synovial fluid is clear, pale, yellow, viscid, and does not clot

188. Chemical Tests
 Glucose- typically a bit lower than blood glucose
levels. May be significantly lower with joint
inflammation and infection.
 Protein- increased with bacterial infection
 Lactate dehydrogenase- increased level may be
seen in rheumatoid arthritis, infectious
arthritis, or gout.
 Uric acid- increased with gout

189. Microscopic Examination
 Total cell count- number of RBC’s and WBC.
Increased WBC may be seen in infections such as
gout & rheumatoid arthritis.
 WBC differential- determines the percentages of
different types of WBC.
 ↑ neutrophil- seen with bacterial infections
 Greater that 2% eosinophil- suggest Lyme disease

190. Clinical Disorders
 Increase volume of the synovial fluid results in a variety of
pathological process
 Non-inflammatory- Osteoarthritis, neuroarthropathy
 Inflammatory- rheumatoid arthritis, gout
 Septic- Bactericidal or fungal infection
 Haemorrhagic- Haemophilia or trauma

191. Tears

193. Enzyme content
 Tears secreted by the lacrimal gland contains the
enzyme lysozyme which protects the cornea from
infection by hydrolyzing the mucopeptide of the
polysaccharide cell walls of many microorganisms.

194. Function
 Keeps the epithelium moist, thereby protecting the
outer covering of the eye from damage due to dryness
 Creates a smooth optical surface on the front of the
cornea
 Acts as the main supplier of oxygen & other nutrients
to the cornea
 Carries waste products from the cornea
 Improves the quality of retinal image by smoothing out
irregularities of the cellular surfaces
 Provide enzymes that destroy bacteria that can harm
the eye

195. Tests
 Schirmer test
 Meniscometry

196. Schirmer Test
 Determines whether the eyes
produces test enough to keep it
moist
 This test is used when a person
experiences very dry eyes or
excessive watering of the eyes
 Performed by placing filter paper
inside the lower lid of the eye &
after a few minutes, the paper is
removed & tested for moisture
content.
 Flourescein eye drops are also used
to test if tears can flow through the
lacrimal ducts into the nose
More than 10 mm of moisture on the
filter paper in 5 minutes is normal

197. Meniscometry
 Meniscometry is a
minimally invasive test,
which is particularly useful
in assessing tear volume
indirectly by measuring tear
meniscus radius.
 The smaller the radius of
curvature, the smaller the
volume of tears present and
the greater the capillary
suction of fluid back into
the menisci from the tear
film.

198. Clinical Disorders
 Crocodile tears syndrome
 Keratoconjunctivitis sicca

199. Crocodile Tears
 An uncommon consequence
of nerve regeneration
subsequent to Bell's palsy or
other damage to the facial
nerve in which efferent fibers
from the superior salivary
nucleus become improperly
connected to nerve axons
projecting to the lacrimal
glands (tear ducts), causing
one to shed tears (lacrimate)
during salivation while
smelling foods or eating.

200. Keratoconjunctivitis sicca
 Dry eye syndrome
 A relativelycommon
condition, especially in
older patients, that is
characterized by inadequate
tear film protection of the
cornea because of either
inadequate tear production
or abnormal tear film
constitution, which results
in excessively fast
evaporation or premature
destruction of the tear film.

201. Human Breast Milk
 Composition & Function
 Fats
 Needed for the development of nervous system
 Insulation & component of cell membrane
Lipid (grams/100ml milk) 4.38
FA (8C) trace
PUFA 0.6(14%)
 Carbohydrates
 Provide energy (lactose is the predominant carb.)
Carbohydrate (grams/100ml milk)
lactose 7
oligosaccharides 0.5

202. Human Breast Milk
 Proteins
 Needed for protein synthesis for growth & development
 Composed mostly of whey (60%-80%) & casein
Protein (grams/100 ml milk) 1.03
casein 0.3
a-lactalbumin 0.3 0.3
lactoferrin 0.2
IgA 0.1
IgG 0.001 0.001
lysozyme 0.05
serum albumin 0.05
ß-lactoglobulin -
 Contains lactoferrin that has bacteriostatic effect
 Contains antibodies, bifidus factor & digestive enzymes

203. Human Breast Milk
 Vitamins, minerals and other nutrients
 Contains a host of vitamins, minerals and other
nutrients that support a host of different biochemical
processes essential for life
Ash (%) 0.20 Riboflavin (mg) 0.036
Calcium (mg) 25-35 Niacin (mg) 0.177
Iron (mg) 0.03 Pantothenic acid 0.223
Magnesium (mg) 3 Vitamin B6 (mg) 10
Phosphorous (mg) 13-16 Folacin (mg) 5
Potassium (mg) 51 Vitamin B12 (mcg) 0.045
Sodium (mg) 17 Vitamin A (mg) 58
Zinc (mg) 0.17 Vitamin D (mg) 0.04
Ascorbic acid (mg) 5 Vitamin E (mg) 0.34
Thiamine (mg) 20 Vitamin C (mg) 4

204. Human Breast Milk
 Control mechanism
 Lactogenesis
 Transforms a mammary gland from its undifferentiated
state to fully differentiated state in late pregnancy
 Stage I – occurs in mid-pregnancy
 ↑ in lactose, total protein and immunoglobulins
 ↓ in Na+ and Cl-
 Stage II – onset of milk secretion
 ↑ in lactose (further increase) and citrate

205. Human Breast Milk
 Control mechanism
 Lactation
 Abrupt ↓ in progesterone (removal of placenta)
initiates milk secretion
 Prolactin
 Stimulates and maintains mammary glandular ductal
growth and milk protein synthesis
 Oxytocin
 Promotes “milk let-down” reflex

206. Human Breast Milk

207. Human Breast Milk
 Enzymes
 Lipase
 For fat breakdown
 Lactoperoxidase and lysozymes
 Bactericidal effect
 Other enzymes
 Transport moieties
for other substances such as zinc,
selenium & magnesium

208. Human Breast Milk
 Diseases associated with breastmilk
 Mastitis
 infection of the tissueof the breast that occurs most
frequently during the time of breastfeeding
 causes pain, swelling, redness, and increased
temperature of the breast
 occurs when bacteria, often from the baby's mouth,
enter a milk duct through a crack in the nipple
 Resolves through antibiotic medication

209. Human Breast Milk
 Subareolar abscess
 abscess or growth on the areolar gland, which is located in the
breast under or below the areola
 cause is blockage of the small glands or ducts under the areola, with
development of an infection under the skin
 Symptoms may occur as:
 Drainage and possible pus from lump beneath areolar area
 Fever
 General ill-feeling
 Swollen, tender lump beneath areolar area
 Treatment done with antibiotics

210. Human Breast Milk
 Duct ectasia syndrome
 occurs when a milk duct beneath nipple becomes dilated → duct
walls thicken → duct fills with fluid → milk duct can then become
blocked or clogged with a thick, sticky substance
 usually improves without treatment
 Antibiotics or surgery only instituted if signs/symptoms persist
 Tenderness in the nipple or surrounding breast tissue
 Redness
 A lump or thickening
 An inverted nipple

211. Human Breast Milk
 Breast engorgement
 can occur due to :
 sudden increased milk production that is common during the first days
after the baby is delivered
 when the baby suddenly stops breastfeeding either because it is starting
to eat solid foods or it is ill and has a poor appetite
 may also be caused when the mother does not nurse or pump the
breast as much as usual
 alveoli become over-distended which can lead to the rupture of the
milk-secreting cells
 can lead to cessation of milk production
 Severe engorgement of the breast can lead to breast infection

212. Human Breast Milk
 Current research for breast milk testing
 breast milk could be used to predict whether she is at risk of
developing breast cancer, according to scientists
 Cells in the milk can easily be tested to see if they contain certain
genes linked to the illness
 the DNA of the milk appears altered to those who have shown to
be (+) to cancer as evidenced by their respective biopsies

213. Sweat
 Composition
 Highly variable, but Na+ and Cl- are the major electrolytes
 Mineral composition varies depending on the person’s activity
 sodium (0.9 gram/liter)
 potassium (0.2 g/l)
 calcium (0.015 g/l)
 magnesium (0.0013 g/l)
 zinc (0.4 milligrams/liter)
 copper (0.3–0.8 mg/l)
 iron (1 mg/l)
 chromium (0.1 mg/l)
 nickel (0.05 mg/l)
 lead (0.05 mg/l)

214. Sweat
 Function
 produced by glands in the deeper layer of the skin,
the dermis
 main function is to control body temperature
 additional function of sweat is to help with gripping,
by slightly moistening the palms

215. Sweat
 Enzyme
 Contains cysteine proteinase inhibitors
 inhibits papain which is known to cleave the Fc portion
of immunoglobulins

216. Sweat
 Test
 Sweat Chloride Test
 common and simple test used to evaluate a patient
who is suspected of having cystic fibrosis (CF)
 iontophoresis is employed to produce the necessary
volume of sweat for the test
 normal sweat chloride = 10-35 mEqs/l
 sweat chloride value < 60 mEqs/l is indicative of CF
 Those having intermediate values are advised to have
the test repeated on a periodic basis

217. Sweat
 Diseases associated with sweat
 Hyperhydrosis
 abnormal increased sweating
 In most cases, cause is unknown. In some cases, however,
causes are:
 Obesity
 Hormonal changes associated with menopause (hot flushes)
 Illnesses associated with fever, such as infection or malaria
 An overactive thyroid gland (hyperthyroidism)
 Diabetes
 Certain medications

218. Sweat
 Idiopathic hyperhydrosis
 most common form of excessive sweating
 Cause is unknown
 can develop during childhood or later in life
 can affect any part of the body, but the palms and
soles or the armpits are the most commonly affected
 occurs even during cool weather, but it is worse during
warm weather and when a person is under emotional
stress

219. Sweat
 Apocrine bromhidrosis
 most prevalent form of bromhidrosis
 bacterial decomposition of apocrine secretion
contribute to its pathogenesis
 yields ammonia and short-chain fatty acids having strong
odors

220. Sweat
 Eccrine bromhidrosis
 Happens when eccrine sweat softens keratin
 bacterial degradation of the keratin yields a foul smell
 Can be caused by ingestion of some foods or drugs
like:
 Garlic
 Onion
 Curry
 Alcohol
 certain drugs (eg: penicillin, bromides)

221. Mechanisms of Detoxification

222. Mechanisms of Detoxification
• Primarily a function of the liver
• Has 2 phases
• Phase I
• Directly neutralizes or converts a substrate into an
intermediate one.
• Phase II
• Renders a non-toxic final product.

223. Phase I
 Involves a group of enzymes – cytochrome P450
family
 Uses O2 and NADH as a cofactor
 Employs varied reactions depending on the
substrate to be detoxified
 Free radicals are produced in the process

224. Phase I

225. Phase I
 Some substances that can cause overactivity of
cytochrome P450 enzymes:
 Caffeine
 Alcohol
 Pesticides
 Sulfonamides
 Barbiturates

226. Phase I
 Phase I can directly neutralize some chemicals
like:
 Caffeine

227. Phase I
 Overactivity of Phase I
 Leads to wide range of chemical tolerances
 Depletion of antioxidants
 Accumulation of intermediate substance
 Predisposition to liver cell damage
 Underactivity of Phase I
 Low tolerance to wide range of chemicals
 Longer detoxification time

228. Phase I
 Inducers of Phase I
 Foods from brassica family
 Cabbage, broccoli, Brussels sprouts
 Also stimulates Phase II detoxification pathway
 Contains Indole-3-carbinol, a powerful anti-cancer
 Citrus fruits
 Oranges, lemons and tangerines
 Contains limonene that is a strong inducer of Phase I &
II

229.  Nutrients
 Niacin, vitamin B1, vitamin C
 Herbs
 Caraway and dill seeds

230. Phase I
 Inhibitors of Phase I
 Drugs
 benzodiazepines; antihistamines; cimetidine;
ketoconazole
 Foods
 naringenin from grapefruit juice
 curcumin from turmeric
 capsaicin form chili pepper
 eugenol from clove oil
 quercetin from onions
 Aging

231. Phase II
 Involves conjugation reactions to neutralize toxins
 Essentially, there are 6 pathways
 Glutathione conjugation
 Amino acid conjugation
 Methylation
 Sulfation
 Acetylation
 Glucuronidation

232. Phase II

233. Phase II: Glutathione conjugation
 Produces water-soluble mercaptates with the help
of enzyme GST

234. Phase II: Amino acid conjugation
 Amino acids take on the action of neutralizing
toxins
 Glycine is the most commonly used AA in Phase II
AA detoxification

235. Phase II: Methylation pathway
 involves conjugating methyl groups to toxins
 methyl groups come from S-adenosyl methionine (SAM)
 synthesized from methionine

236. Phase II: Methylation pathway
 Inactivates drugs through methylation like estrogens

237. Phase II: Sulfation pathway
 conjugation of toxins with sulfur-containing compounds

238. Phase II: Sulfation pathway
 Main pathway for detoxification od steroids and thyroid
hormones
 Primary route for elimination of neurotransmitters

239. Phase II: Acetylation pathway
 Conjugation of toxins with acetyl-CoA
 Primary elimination of sulfa drugs
 Detoxifies many environmental toxins, including tobacco smoke
and exhaust fumes

240. Phase II: Glucuronidation pathway
 Combines glucuronic acid with toxins
 requires the enzyme UDP-glucuronyl transferase (UDPGT)
 major inactivating pathway for lots of toxins

241. Phase II: Glucuronidation pathway
 Glucuronidation of Etoposide

242. Phase II
 Inducers of Phase II
 Glutathione conjugation:
 Brassica family foods (cabbage, broccoli, Brussels
sprouts); limonene-containing foods (citrus peel, dill
weed oil, caraway oil)
 Amino acid conjugation:
 Glycine
 Methylation:
 Lipotropic nutrients
(choline, methionine, betaine, folic acid, vitamin B12)

243. Phase II
 Inducers of Phase II
 Sulfation:
 Cysteine, methionine, taurine
 Acetylation:
 most vegetables and fruits but especially cruciferous
vegetables
 Glucuronidation:
 Fish oils, limonene-containing foods

244. Phase II
 Inhibitors of Phase II
 Glutathione conjugation:
 Selenium deficiency, vitamin B2 deficiency, glutathione
deficiency, zinc deficiency
 Amino acid conjugation:
 Low protein diet
 Methylation:
 Folic acid or vitamin B12 deficiency

245. Phase II
 Inhibitors of Phase II
 Sulfation:
 Non-steroidal anti-inflammatory drugs (e.g. aspirin),
tartrazine (yellow food dye), molybdenum
 Acetylation:
 Vitamin B2, B5, or C deficiency
 Glucuronidation:
 Aspirin, probenecid