D1.

Human Nutrition
Essential Nutrients and Energy
1. Outline why nutrients cannot be synthesised by the body, and why they have to be
included in the diet
A nutrient is a chemical substance found in foods that is used in the human body.
There are six classes of nutrients – carbohydrates, proteins, lipids, vitamins, minerals
and water. Essential nutrients are those that cannot be synthesised by the body and
must be ingested as part of the diet. Non-essential nutrients can be made by the body
or have a replacement nutrient which serves the same dietary purpose.
Carbohydrates are not considered essential nutrients as human diets can obtain
energy from other sources without ill effect.

2. Describe how malnutrition may be caused by a deficiency, imbalance or excess of

nutrients in the diet
Malnutrition is a health condition caused by a deficiency, imbalance or excess of
nutrients in the diet. It can be caused by an improper dietary intake of nutrients – e.g.
overnutrition (too much) or undernutrition (not enough). It can be caused by the
inadequate utilisation of nutrients by the body – e.g. due to illness or disease.
The symptoms of malnutrition will vary according to the specific nutrient and the type
of imbalance involved. Common signs of malnutrition included stunted growth and
wasting (undernutrition), as well as obesity (over nutrition).

Determining Energy Content

3. Determine the energy content of food by combustion
The energy content of food can be estimated by burning a sample of known mass and
measuring the energy released via calorimetry. Combustion of the food source causes
the stored energy to be released as heat, which raises the temperature of water. The
amount of energy required to raise 1 g of water by 1ºC is4.18 J – this is the specific
heat capacity of water.
The equation for calculating the energy content of a food source via calorimetry is as
follows:
Energy ( joules) = Mass of water (g) × 4.2 (J/gºC) × Temperature increase (ºC)

The biggest source of error in calorimetry is usually caused by the unwanted loss of
heat to the surrounding environment. The food sources should be burnt at a constant
distance from the water to ensure reliability of results. The initial temperature and
volume of water should also be kept constant (1 g of water = 1 cm3 or 1 ml).

Comparing Energy Content

The three types of nutrients that are commonly used as energy sources are
carbohydrates, lipids (fats) and proteins.
- Carbohydrates are preferentially used as an energy source because they are
easier to digest and transport
- Lipids can store more energy per gram but are harder to digest and transport
(hence are used for long-term storage)
- Protein metabolism produces nitrogenous waste products which must be
removed from cells

The relative energy content of carbohydrates, proteins and fats are as follows:
- Carbohydrates – 1,760 kJ per 100 grams
- Proteins – 1,720 kJ per 100 grams
- Fats – 4,000 kJ per 100 grams
Amino Acids and Lipids
4. Explain why some amino acids are essential and how a lack of essential amino
acids affects the production of proteins
Amino acids are the monomeric building blocks from which proteins are constructed.
There are 20 different amino acids which are universal to all living organisms.
Amino acids can be either essential, non-essential or conditionally non-essential
according to dietary requirements. Essential amino acids cannot be produced by the
body and must be present in the diet. Non-essential amino acids can be produced by
the body and are therefore not required as part of the diet. Conditionally non-essential
amino acids can be produced by the body, but at rates lower than certain conditional
requirements (e.g. during pregnancy or infancy) – they are essential at certain times
only.
A shortage of one or more essential amino acids in the diet will prevent the production
of specific proteins. This is known as protein deficiency malnutrition and the health
effects will vary depending on the amino acid shortage.

5. Outline the cause and treatment of phenylketonuria (PKU)

Phenylketonuria (PKU) is a genetic condition that results in the impaired metabolism of
the amino acid phenylalanine. It is an autosomal recessive disease caused by a
mutation to the gene encoding the enzyme phenylalanine hydroxylase. Phenylalanine
hydroxylase (PAH) normally converts excess phenylalanine within the body into
tyrosine. In people with PKU, the excess phenylalanine is instead converted into
phenylpyruvate (also known as phenylketone). This results in a toxic build up of
phenylketone in the blood and urine (hence phenylketonuria).
Untreated PKU can lead to brain damage and mental retardation, as well as other
serious medical problems. Infants with PKU are normal at birth because the mother is
able to break down phenylalanine during pregnancy. Diagnosis of PKU is made by a
simple blood test for elevated phenylalanine levels shortly after birth.
PKU is treated by enforcing a strict diet that restricts the intake of phenylalanine to
prevent its build up within the body. This low-protein diet should include certain types
of fruits, grains, vegetables and special formula milk. This diet should be
supplemented with a medical formula that contains precise quantities of essential
amino acids. Patients who are diagnosed
early and maintain this strict diet can have
a normal life span without damaging
symptoms.
6. Explain why some fatty acids are essential
Humans can synthesise most fatty acids from carbohydrates, but two
(cis)-polyunsaturated fatty acids are considered essential. Alpha-linolenic acid (an
omega-3 fatty acid) and linoleic acid (an omega-6 fatty acid) cannot be synthesised by
the body. This is because humans lack the enzyme required to introduce double
bonds at the required position of the carbon chain.
Essential fatty acids are modified by the body to make important lipid-based
compounds (such as signalling molecules). There is evidence to suggest dietary
deficiencies of these fatty acids may be linked to impaired brain development (e.g.
depression) and altered maintenance of cardiac tissue (e.g. abnormal heart function) –
although this evidence is contested.
Foods rich in essential fatty acids (omega-3 and omega-6) include fish, leafy
vegetables and walnuts.

7. Explain the use of Cholesterol in blood as an indicator of the risk of coronary heart
disease
Fats and cholesterol cannot dissolve in the bloodstream and so are packaged with
proteins (to form lipoproteins) for transport.
- Low density lipoproteins (LDLs) carry cholesterol from the liver to the body
(hence raise blood cholesterol levels)
- High density lipoproteins (HDLs) carry excess cholesterol back to the liver for
disposal (hence lower blood cholesterol levels)

The mix of fatty acids consumed as part of a diet directly influences the levels of
cholesterol in the bloodstream:
- Saturated fats increase LDL levels within the body, raising blood cholesterol
levels
- Trans fats increase LDL levels and lower HDL levels, significantly raising blood
cholesterol levels
- Cis-polyunsaturated fats raise HDL levels, lowering blood cholesterol levels

High cholesterol levels in the bloodstream lead to the hardening and narrowing of
arteries (atherosclerosis). When there are high levels of LDL in the bloodstream, the
LDL particles will form deposits in the walls of the arteries. The accumulation of fat
within the arterial wall leads to the development of plaques which restrict blood flow. If
coronary arteries become blocked, coronary heart disease (CHD) will result – this
includes heart attacks and strokes.
Vitamins and Minerals
8. Describe why vitamins are chemically diverse carbon compounds that cannot be
synthesised by the body
Vitamins are organic molecules with complex chemical structures that are quite
diverse and hence categorised by groups. Water soluble vitamins need to be
constantly consumed as any excess is lost in urine (e.g. vitamins B, C). Fat soluble
vitamins can be stored within the body (e.g. vitamins A, D, E, K).
The functions of vitamins are as diverse as their structure, although many function as
cofactors, antioxidants or hormones. Many vitamins are essential as they cannot be
synthesised by the body and their absence may cause a deficiency disease.

9. Outline why the production of ascorbic acid is practiced by some mammals, but
not others that need a dietary supply
Ascorbic acid is a form of vitamin C that is required for a range of metabolic activities
in all animals and plants. In mammals it functions as a potent antioxidant and also
plays an important role in immune function. It is also involved in the synthesis of
collagen (a structural protein) and in the synthesis of lipoproteins.
Ascorbic acid is made internally by most mammals from monosaccharides – but it is
not produced by humans. Consequently, human must ingest vitamin C as part of their
dietary requirements in order to avoid adverse health effects
A deficiency in vitamin C levels will lead to the development of scurvy and a general
weakening of normal immune function. Common food sources of vitamin C include
citrus fruits and orange juice.

10. Explain why a lack of Vitamin D or calcium can affect bone mineralization and
cause rickets or osteomalacia
Vitamin D is involved in the absorption of calcium and phosphorus by the body –
which contribute to bone mineralisation. In the absence of sufficient amounts of this
vitamin, these elements are not absorbed but instead excreted in the faeces. This can
lead to the onset of diseases such as osteomalacia (where bones soften) or rickets
(where bones are deformed).
Vitamin D can be naturally synthesised by the body when a chemical precursor is
exposed to UV light (i.e. sunlight). The vitamin D may be stored by the liver for when
levels are low (e.g. during winter when sun exposure is reduced). Individuals with
darker skin pigmentation produce vitamin D more slowly and hence require greater
sun exposure.
Vitamin D deficiencies are usually restricted to individuals with highly limited sun
exposure (e.g. elderly, certain ethnicities). While excess sun exposure is beneficial for
vitamin D production, it also increases the risks of developing skin cancers.
11. Outline why dietary minerals are essential chemical elements
Dietary minerals are chemical elements required as essential nutrients by organisms.
Minerals present in common organic molecules are not considered essential – e.g. C,
H, O, N, S. Minerals include calcium (Ca), magnesium (Mg), iron (Fe), phosphorus (P),
sodium (Na), potassium (K) and chlorine (Cl).

Minerals in Human Development

Some of the important functions played by minerals are listed below:
- Major constituents of structures such as teeth and bones (e.g. Ca, P, Mg)
- Important components of body fluids (e.g. Na, K, Cl)
- Cofactors for specific enzymes or components of proteins and hormones (e.g.
Fe, P, I)

A deficiency in one or more dietary mineral can result in a disorder (e.g. lack of
calcium can affect bone mineralisation)

Minerals in Plant Development

Minerals are also important in plant development, making fruits and vegetables a
good source of certain dietary minerals. Magnesium is an important component of
chlorophyll (required for photosynthesis). Potassium is an inorganic salt found within
the sap of a plant (maintains water potential). Calcium is important for plant root and
shoot elongation.
Appetite and Dietary Intake
12. Describe how appetite is controlled by a centre in the hypothalamus
Appetite is controlled by hormones produced in the pancreas, stomach, intestines and
adipose tissue. These hormones send messages to the appetite control centre of the
brain (within the hypothalamus). Hormonal signals will either trigger a feeling of
hunger (promote feasting) or satiety (promote fasting).
The release of hormones can be triggered in a number of ways:
- Stretch receptors in the stomach and intestine become activated when
ingested food distends these organs
- Adipose tissue releases hormones in response to fat storage
- The pancreas will release hormones in response to changes in blood sugar
concentrations

Hormones will either stimulate or inhibit the appetite control centre to promote
sensations of hunger or satiety. Hormones that trigger a hunger response include
ghrelin (from stomach) and glucagon (from pancreas). Hormones that trigger a satiety
response include leptin (from adipose tissue) and CCK (from intestine).
Hint: Ghrelin Grows Hunger ; Leptin Lowers Hunger

13. Explain why overweight individuals are more likely to suffer hypertension and type
II diabetes and how starvation can lead to breakdown of body tissue
Changes in diet and appetite control may result in individuals over-indulging or
under-indulging during meals. Individuals who overeat are likely to gain weight and
develop obesity-related illnesses. Individuals who undereat are likely to lose weight
and exhibit starvation symptoms.
 Obesity
Clinical obesity (BMI > 30) describes a significant excess in body fat and is caused by a
combination of two factors:
- Increased energy intake (i.e. overeating or an increased reliance on diets rich
in fats and sugars)
- Decreased energy expenditure (i.e. less exercise resulting from an increasingly
sedentary lifestyle)
Individuals who are overweight or obese are more likely to suffer from
hypertension(abnormally high blood pressure)
- Excess weight places more strain on the heart to pump blood, leading to a
faster heart rate and higher blood pressure
- High cholesterol diets will lead to atherosclerosis, narrowing the blood vessels
which contributes to raised blood pressure
- Hypertension is a common precursor to the development of coronary heart
disease (CHD)

Individuals who are overweight or obese are also more likely to suffer from type II
diabetes (non-insulin dependent). Type II diabetes occurs when fat, liver and muscle
cells become unresponsive to insulin (insulin insensitivity). This typically results from a
diet rich in sugars causing the progressive overstimulation of these cells by insulin.
Hence overweight individuals who have a high sugar intake are more likely to develop
type II diabetes.

Starvation
Starvation describes the severe restriction of daily energy intake, leading to a
significant loss of weight. As the body is not receiving a sufficient energy supply from
the diet, body tissue is broken down as an energy source. This leads to muscle loss
(as muscle proteins are metabolised for food) and eventually organ damage (and
death).

14. Explain the breakdown of heart muscle due to anorexia

Anorexia nervosa is an eating disorder in which individuals severely limit the amount
of food they intake. It is most common in young females with body image anxiety and
can potentially be fatal if left untreated

In severe anorexia, the body begins to break down heart muscle, making heart
disease the most common cause of death. Blood flow is reduced and blood pressure
may drop as heart tissue begins to starve. The heart may also develop dangerous
arrhythmias and become physically diminished in size.
15. Use a databases of nutritional content of foods and software to calculate intakes
of essential nutrients from a daily diet
The recommended daily intake for a nutrient (RDI) is the daily dietary level required to
meet the requirements of health. It is an estimate only and will vary according to age,
gender, activity levels and medical conditions.
The recommendations are based on a daily energy intake of 8400 kJ (2000 kcal) for
healthy adults. On food packages, this information is usually presented as a
percentage of a daily total (based on identified serving size).

Dietary intake can be recorded and compared against levels of energy expenditure in
order to monitor weight change. There are a variety of online databases and software
programs that can be used to calculate dietary intake and expenditure.
D2. Digestion
Exocrine Glands and Gastric Secretions
1. Explain how exocrine glands secrete to the surface of the body or the lumen of the
gut
Exocrine glands produce and secrete substances via a duct onto an epithelial surface
– either:
- The surface of the body (e.g. sweat glands, sebaceous glands)
- The lumen of the digestive tract / gut (e.g. digestive glands)

Examples of digestive glands include:

- Salivary glands – secrete saliva which contains amylase (breaks down starch)
- Gastric glands – secretes gastric juices which includes hydrochloric acid and
proteases (breaks down protein)
- Pancreatic glands – secretes pancreatic juices which include lipase, protease
and amylase
- Intestinal glands – secretes intestinal juices via crypts of Lieberkuhn in the
intestinal wall

2. Identify exocrine gland cells that secrete digestive juices and villus epithelium cells
that absorb digested foods from electron micrographs
Exocrine glands are composed of a cluster of secretory cells which collectively form
an acinus (plural = acini). The acini are surrounded by a basement membrane and
are held together by tight junctions between secretory cells. The secretory cells
possess a highly developed ER and golgi network for material secretion and are rich
in mitochondria.

Exocrine products are released (via secretory vesicles) into a duct, which connects to
an epithelial surface. These ducts may arise from a convergence of smaller ductules
(each connected to an acinus) in order to enhance secretion.

3. Outline how the nervous and hormonal mechanisms control the secretion of
digestive juices and how the volume and content of gastric secretions are
controlled by nervous and hormonal mechanisms
The secretion of digestive juices is controlled by both nervous and hormonal
mechanisms. These mechanisms control both the volume of secretions produced and
the specific content (e.g. enzymes, acids, etc.).
 Nervous Mechanism
The sight and smell of food triggers an immediate response by which gastric juice is
secreted by the stomach pre-ingestion. When food enters the stomach it causes
distension, which is detected by stretch receptors in the stomach lining. Signals are
sent to the brain, which triggers the release of digestive hormones to achieve
sustained gastric stimulation.

Hormonal Mechanism
Gastrin is secreted into the bloodstream from the gastric pits of the stomach and
stimulates the release of stomach acids. If stomach pH drops too low (becomes too
acidic), gastrin secretion is inhibited by gut hormones (secretin and somatostatin).
When digested food (chyme) passes into the small intestine, the duodenum also
releases digestive hormones:
- Secretin and cholecystokinin (CCK) stimulate the pancreas and liver to release
digestive juices
- Pancreatic juices contain bicarbonate ions which neutralise stomach acids,
while the liver produces bile to emulsify fats

Stomach Acid and Intestinal Villi

4. Explain why some conditions in the stomach favour some hydrolysis reactions and
help to control pathogens in ingested food
The gastric glands that line the stomach wall secrete an acidic solution that creates a
low pH environment within the stomach. The normal pH of the stomach is roughly 1.5
– 2.0, which is the optimum pH for hydrolysis reactions by stomach enzymes.

The acid conditions in the stomach serve a number of functions:

- Assists in the digestion of food (by dissolving chemical bonds within food
molecules)
- Activates stomach proteases (e.g. pepsin is activated when pepsinogen is
proteolytically cleaved in acid conditions)
- Prevents pathogenic infection (stomach acids destroy microorganisms in
ingested food)

The stomach wall is lined by a layer of mucus, which protects the stomach lining from
being damaged by the acid conditions. The pancreas releases bicarbonate ions into
the duodenum which neutralises the stomach pH (intestinal pH ~7.0 – 8.0). Certain
foods (e.g. antacids) may also neutralise stomach acids,
impairing digestion and increasing chances of infection.
5. Outline the reduction of stomach acid secretion by proton pump inhibitor drugs
The low pH environment of the stomach is maintained by proton pumps in the parietal
cells of the gastric pits. These proton pumps secrete H+ ions (via active transport),
which combine with Cl–ions to form hydrochloric acid. Certain medications and
disease conditions can increase the secretion of H+ ions, lowering the pH in the
stomach.

Proton pump inhibitors (PPIs) are drugs which irreversibly bind to the proton pumps
and prevent H+ ion secretion. This effectively raises the pH in the stomach to prevent
gastric discomfort caused by high acidity (e.g. acid reflux). Individuals taking PPIs may
have increased susceptibility to gastric infections due to the reduction of acid
secretion.

6. Describe how the structure of cells of the epithelium of the villi is adapted to the
absorption of food
Once digested food has passed through the stomach, it enters the small intestine for
absorption into the blood. The small intestine also releases digestive enzymes to
ensure the complete hydrolysis of food molecules.

The inner epithelial lining of the small intestine is highly folded into finger-like
projections called villi (singular: villus). Many villi will protrude into the intestinal lumen,
greatly increasing the available surface area for material absorption

Features of Villi
Intestinal villi contain several structural features which facilitate the absorption of
digestive products:
- Microvilli – Ruffling of epithelial membrane further increases surface area
- Rich blood supply – Dense capillary network rapidly transports absorbed
products
- Single layer epithelium – Minimises diffusion distance between lumen and
blood
- Lacteals – Absorbs lipids from the intestine into the lymphatic system
- Intestinal glands – Exocrine pits
(crypts of Lieberkuhn) release
digestive juices
- Membrane proteins – Facilitates
transport of digested materials
into epithelial cells
7. Identify the exocrine gland cells that secrete digestive juices and villus epithelium
cells that absorb digested foods from electron micrographs
The epithelial lining of villi contains several structural features which optimise its
capacity to absorb digested materials:

Tight Junctions
- Occluding associations between the plasma membrane of two adjacent cells,
creating an impermeable barrier
- They keep digestive fluids separated from tissues and maintain a
concentration gradient by ensuring one-way movement

Microvilli
- Microvilli borders significantly increase surface area of the plasma membrane
(>100×), allowing for more absorption to occur
- The membrane will be embedded with immobilised digestive enzymes and
channel proteins to assist in material uptake

Mitochondria
- Epithelial cells of intestinal villi will possess large numbers of mitochondria to
provide ATP for active transport mechanisms
- ATP may be required for primary active transport (against gradient), secondary
active transport (co-transport) or pinocytosis

Pinocytotic Vesicles
- Pinocytosis (‘cell-drinking’) is the non-specific uptake of fluids and dissolved
solutes (a quick way to translocate in bulk)
- These materials will be ingested via the breaking and reforming of the
membrane and hence contained within a vesicle
Dietary Fibre and Digestive Infections
8. Explain thatc rate of transit of materials through the large intestine is positively
correlated with their fibre content
The human intestines function to complete the process of digestion and absorb
digested products into the bloodstream. The small intestine absorbs usable food
substances (i.e. nutrients – monosaccharides, amino acids, fatty acids, vitamins, etc.).
The large intestine absorbs water and dissolved minerals (i.e. ions) from the
indigestible food residues.

Dietary Fibre
Dietary fibre, or roughage, is the indigestible portion of food derived principally from
plants and fungi (cellulose, chitin, etc.). Humans lack the necessary enzymes to break
down certain plant matter (e.g. lack cellulase required to digest cellulose). Certain
herbivores (ruminants) possess helpful bacteria in the digestive tract that can break
down indigestible plant matter.

The rate of transit of materials through the large intestine is positively correlated with
their fibre content:
- Roughage provides bulk in the intestines to help keep materials moving
through the gut
- Roughage also absorbs water, which keeps bowel movements soft and easy to
pass

There are several health benefits associated with diets rich in dietary fibre:
- It reduces the frequency of constipation and lowers the risk of colon and rectal
cancer
- It lowers blood cholesterol and regulates blood sugar levels (by slowing the
rate of absorption)
- It aids in weight management (contributes few calories despite consisting of a
large volume of ingested material)

Egestion
Materials that are not absorbed by the small and large intestines are ultimately
egested from the body as faeces. A large portion of human faeces consists of dietary
fibre, such as cellulose and lignin. Also present in faeces are the remains of intestinal
epithelial cells, bile pigments and human flora (intestinal bacteria).

Summary of egested materials:

- Bile pigments
- Epithelial cells
- Lignin
- Cellulose
- Human flora (bacteria)
9. Use Helicobacter pylori infection as a cause of stomach ulcers
Stomach ulcers are inflamed and damaged areas in the stomach wall, typically caused
by exposure to gastric acids. There is a strong positive correlation between
Helicobacter pylori infection and the development of stomach ulcers

Helicobacter pylori is a bacterium that can survive the acid conditions of the stomach
by penetrating the mucus lining; it anchors to the epithelial lining of the stomach,
underneath the mucus lining. An inflammatory immune response damages the
epithelial cells of the stomach – including the mucus-secreting goblet cells. This
results in the degradation of the protective mucus lining, exposing the stomach wall to
gastric acids and causing ulcers.
The prolonged presence of stomach ulcers may lead to the development of stomach
cancer over many years (20 – 30 years). H. pylori infections can be treated by
antibiotics (previously, stomach ulcers were considered stress related and not
treatable).

10. Explain dehydration due to cholera toxin

Vibrio cholerae is a bacterial pathogen that infects the intestines and causes acute
diarrhoea and dehydration. The associated disease – cholera – can kill within hours
unless treated with oral rehydration therapies.

V. cholerae releases a toxin that binds to ganglioside receptors on the surface of

intestinal epithelium cells. This toxin is internalised by endocytosis and triggers the
production of cyclic AMP (a second messenger) within the cell. Cyclic AMP (cAMP)
activates specific ion channels within the cell membrane, causing an efflux of ions
from the cell. The build up of ions in the intestinal lumen draws water from cells and
tissues via osmosis – causing acute diarrhoea. As water is being removed from body
tissues, dehydration will result if left untreated.
D3. Functions of the Liver
Liver Blood Flow and Structure
1. Outline how the liver intercepts blood from the gut to regulate nutrient levels
The liver is a lobed organ located below the diaphragm that functions to regulate the
chemical composition of blood. It receives oxygenated blood via the hepatic artery,
which is used to sustain liver cells (hepatocytes). It also receives nutrient rich blood
from the gut via the portal vein. Deoxygenated blood is transported from the liver via
the hepatic vein.

The liver functions to process the nutrients absorbed from the gut and hence
regulates the body’s metabolic processes. It is responsible for the storage and
controlled release of key nutrients (e.g. glycogen, cholesterol, triglycerides), as well as
for the detoxification of potentially harmful ingested substances (e.g. amino acids,
medications, alcohol). It produces plasma proteins that function to maintain
sustainable osmotic conditions within the bloodstream, and is further responsible for
the breakdown of red blood cells and the production of bile salt.

2. Dual blood supply to the liver and differences between sinusoids and capillaries
Hepatic Lobules
The liver is composed of smaller histological structures called lobules, which are
roughly hexagonal in shape. Each lobule is surrounded by branches of the hepatic
artery (provide oxygen) and the portal vein (provide nutrients). These vessels drain into
capillary-like structures called sinusoids, which exchange materials directly with the
hepatocytes. The sinusoids drain into a central vein, which feeds deoxygenated blood
into the hepatic vein. Hepatocytes also produce bile, which is transported by vessels
called canaliculi to bile ducts, which surround the lobule.
 Sinusoids
Sinusoids are a type of small blood vessel found in the liver that perform a similar
function to capillaries (material exchange). They have increased permeability, allowing
larger molecules (e.g. plasma proteins) to enter and leave the bloodstream.

The increased permeability of sinusoids is important for liver function and is due to a
number of structural features:
- The surrounding diaphragm (basement membrane) is incomplete or
discontinuous in sinusoids (but not in capillaries)
- The endothelial layer contains large intercellular gaps and fewer tight junctions
(allowing for the passage of larger molecules)

Nutrient Supply and Detoxification

3. Describe how some nutrients in excess can be stored in the liver and how surplus
cholesterol is converted into bile salts
The liver plays an important role in regulating the levels of nutrients in the
bloodstream. Nutrients absorbed by the small intestine are transported by the hepatic
portal vein to the liver for metabolism. The liver converts these nutrients into forms
that can be stored or used and mediates their transport to various tissues. Nutrients
stored within the liver include glycogen, iron, vitamin A and vitamin D.

Carbohydrate Metabolism
Excess glucose in the bloodstream (e.g. after meals) is taken up by the liver and stored
as glycogen. When blood glucose levels drop, the liver breaks down glycogen into
glucose and exports it to body tissues. When hepatic glycogen reserves become
exhausted, the liver synthesises glucose from other sources (e.g. fats). These
metabolic processes are coordinated by the pancreatic hormones – insulin and
glucagon.

Protein Metabolism
The body can not store amino acids, meaning they must be broken down when in
excess. Amino acid breakdown releases an amine group (NH2), which cannot be used
by the body and is potentially toxic. The liver is responsible for the removal of the
amine group (deamination) and its conversion into a harmless product. The amine
group is converted into urea by the liver, which is excreted within urine by the kidneys
The liver can also synthesise non-essential amino acids from surplus stock (via
transamination).
 Fat Metabolism
The liver is the major site for converting excess carbohydrates and proteins into fatty
acids and triglycerides. It is also responsible for the synthesis of large quantities of
phospholipids and cholesterol . These compounds are then stored by the liver or
exported to cells by different types of lipoproteins. Low density lipoprotein (LDL)
transports cholesterol to cells, for use in the cell membrane and in steroid synthesis.
High density lipoprotein (HDL) transports excess cholesterol from cells back to the
liver (for storage or conversion). LDL is considered ‘bad’ as it raises blood cholesterol
levels, while HDL lowers cholesterol levels and is therefore ‘good’. Surplus cholesterol
is converted by the liver into bile salts, which can be eliminated from the body via the
bowels.

4. Outline how the liver removes toxins from the blood and detoxifies them
The liver acts on drugs and toxins that have entered the bloodstream. Many of these
toxic compounds are fat soluble, making them difficult for the body to excrete. These
compounds are converted into less harmful and more soluble forms, which are then
excreted from the body.

The detoxification of compounds by the liver typically involves two sets of chemical
pathways:
- Toxins are converted into less harmful chemicals by oxidation, reduction and
hydrolysis reactions
- These reactions are mediated by a group of enzymes known as the
cytochrome P450 enzyme group
- These conversions produce damaging free radicals, which are
neutralised by antioxidants within the liver
- The converted chemical is then attached to another substance (e.g. cysteine)
via a conjugation reaction
- This renders the compound even less harmful and also functions to
make it water soluble
- The water soluble compounds can now be excreted from the body
within urine by the kidneys
Plasma Proteins and Erythrocyte Recycling
5. Outline how the endoplasmic reticulum and Golgi apparatus in hepatocytes
produce plasma proteins
Plasma proteins are proteins present in the blood plasma and are produced by the
liver (except for immunoglobulins). The proteins are produced by the rough ER in
hepatocytes and exported into the blood via the Golgi complex.

There are a number of different types of plasma proteins, each serving different
specific functions:

- Albumins regulate the osmotic pressure of the blood (and hence moderate the
osmotic pressure of body fluids)
- Globulins participate in the immune system (i.e. immunoglobulins) and also act
as transport proteins
- Fibrinogens are involved in the clotting process (soluble fibrinogen can form
an insoluble fibrin clot)
- Low levels of other plasma proteins have various functions (e.g. α-1-antitrypsin
neutralises digestive trypsin)

6. Describe how the components of red blood cells are recycled by the liver
In humans, red blood cells possess minimal organelles and no nucleus in order to
carry more haemoglobin. Consequently, red blood cells have a short lifespan (~120
days) and must be constantly replaced.

The liver is responsible for the breakdown of red blood cells and recycling of its
components. These components are used to make either new red blood cells or other
important compounds (e.g. bile).

7. Explain the breakdown of erythrocytes starting with phagocytosis of red blood

cells by Kupffer cells and how iron is carried to the bone marrow to produce
haemoglobin in new red blood cells
Kupffer cells are specialised phagocytes within the liver which engulf red blood cells
and break them down. Kupffer cells break down haemoglobin into globin and
iron-containing heme groups. Globin is digested by peptidases to produce amino
acids (which are either recycled or metabolised by the liver). Heme groups are broken
down into iron and bilirubin (bile pigment).
 The released iron must be complexed within a protein in order to avoid oxidation to a
ferric state. Iron can be stored by the liver within a protein shell of ferritin and can be
transported to the bone marrow (where new haemoglobin is produced) within the
protein transferrin.

8. Outline the causes and consequences of jaundice

Jaundice is a condition caused by an excess of bile pigment – bilirubin – within the
body. Bilirubin is produced as part of the natural breakdown of haemoglobin by the
liver. Normally, the liver conjugates this bilirubin to other chemicals and then secretes
it in bile. When there is an excess of bilirubin, it may leak out into surrounding tissue
fluids.c

Jaundice may be caused by any condition which impairs the natural breakdown of red
blood cells, including:
- Liver disease – impaired removal of bilirubin by the liver may cause levels to
build within the body
- Obstruction of the gallbladder – preventing the secretion of bile will cause
bilirubin levels to accumulate
- Damage to red blood cells – increased destruction of erythrocytes (e.g.
anemia) will cause bilirubin levels to rise

The main consequence of jaundice is a yellowish discoloration of the skin and whites
of the eyes (sclera). Other common symptoms include itchiness, paler than usual
stools and darkened urine.

Jaundice may be resolved by treating the underlying cause for the build up of bilirubin
within the body.
D4. The Heart
Cardiac Muscle and Conduction
1. Outline how the structure of cardiac muscle cells allows propagation of stimuli
through the heart wall
The heart is composed of cardiac muscle cells which have specialised features that
relates to their function:
- Cardiac muscle cells contract without stimulation by the central nervous
system (contraction is myogenic)
- Cardiac muscle cells are branched, allowing for faster signal propagation and
contraction in three dimensions
- Cardiac muscles cells are not fused together, but are connected by gap
junctions at intercalated discs
- Cardiac muscle cells have more mitochondria, as they are more reliant on
aerobic respiration than skeletal muscle

These structural features contribute to the unique functional properties of the cardiac
tissue:
- Cardiac muscle has a longer period of contraction and refraction, which is
needed to maintain a viable heartbeat
- The heart tissue does not become fatigued (unlike skeletal muscle), allowing
for continuous, life long contractions
- The interconnected network of cells is separated between atria and ventricles,
allowing them to contract separately

2. Describe how signals from the sinoatrial node that cause contraction cannot pass
directly from atria to ventricles and why there is a delay between the arrival and
passing on of a stimulus at the atrioventricular node
Cardiac muscle cells are not fused together but are instead connected via gap
junctions at intercalated discs. This means that while electrical signals can pass
between cells, each cell is capable of independent contraction. The coordinated
contraction of cardiac muscle cells is controlled by specialised autorhythmic cells
(‘pace makers’).

Atrial Contraction
Within the wall of the right atrium is a specialised cluster of cardiomyocytes which
directs the contraction of heart tissue. This cluster of cells is collectively called the
 sinoatrial node (SA node or SAN). The sinoatrial node acts as a primary pacemaker,
controlling the rate at which the heart beats (i.e. pace 'making’). It sends out electrical
signals which are propagated throughout the entire atria via gap junctions in the
intercalated discs. In response, the cardiac muscle within the atrial walls contract
simultaneously (atrial systole).

The atria and ventricles of the heart are separated by a fibrous cardiac skeleton
composed of connective tissue. This connective tissue functions to anchor the heart
valves in place and cannot conduct electrical signals. The signals from the sinoatrial
node must instead be relayed through a second node located within this cardiac
skeleton. This second node is called the atrioventricular node (or AV node) and
separates atrial and ventricular contractions. The AV node propagates electrical
signals more slowly than the SA node, creating a delay in the passing on of the signal.

3. Explain that this delay allows time for atrial systole before the atrioventricular
valves close and that conducting fibres ensure coordinated contraction of the
entire ventricle wall
The separation of atrial and ventricular contraction is important as it optimises the flow
of blood between the heart chambers. The delay in time following atrial systole allows
for blood to fill the ventricles before the atrioventricular valves close.

Ventricular Contraction
Ventricular contraction occurs following excitation of the atrioventricular node(located
at the atrial and ventricular junction). The AV node sends signals down the septum via
a specialised bundle of cardiomyocytes called the Bundle of His. The Bundle of His
innervates Purkinje fibresin the ventricular wall, which causes the cardiac muscle to
contract. This sequence of events ensures contractions begin at the apex (bottom),
forcing blood up towards the arteries.
 Heart Relaxation / Diastole
After every contraction of the heart, there is a period of insensitivity to stimulation (i.e.
a refractory period). This recovery period (diastole) is relatively long, and allows the
heart to passively refill with blood between beats. This long recovery period also helps
prevent heart tissue becoming fatigued, allowing contractions to continue for life.

Heart Sounds, Electrocardiography, and Cardiac Output

4. Describe that normal heart sounds are caused by the atrioventricular valves and
semilunar valves closing causing changes in blood flow
The heart contains a number of heart valves which prevent the backflow of blood. This
ensures the one-way circulation of blood around the body

There are two sets of valves located within the heart:

- Atrioventricular valves (tricuspid and bicuspid) prevent blood in the ventricles
from flowing back into the atria
- Semilunar valves (pulmonary and aortic) prevent blood in the arteries from
flowing back into the ventricles

Heart sounds are made when these two sets of valves close in response to pressure
changes within the heart. The first heart sound is caused by the closure of the
atrioventricular valves at the start of ventricular systole. The second heart sound is
caused by the closure of the semilunar valves at the start of ventricular diastole.
 5. Map cardiac cycle to a normal ECG trace
The cardiac cycle describes the series of events that take place in the heart over the
duration of a single heartbeat. It is comprised of a period of contraction (systole) and
relaxation (diastole).

The cardiac cycle can be mapped by recording the electrical activity of the heart with
each contraction. Activity is measured using a machine called an electrocardiograph
to generate data called an electrocardiogram.
Hint: In a similar fashion, you use a telegraph (machine) to send a telegram(data).

Each normal heart beat should follow the same sequence of electrical events:. The P
wave represents depolarisation of the atria in response to signalling from the sinoatrial
node (i.e. atrial contraction). The QRS complex represents depolarisation of the
ventricles (i.e. ventricular contraction), triggered by signals from the AV node. The T
wave represents repolarisation of the ventricles (i.e. ventricular relaxation) and the
completion of a standard heart beat. Between these periods of electrical activity are
intervals allowing for blood flow (PR interval and ST segment).

Examples of Heart Conditions

Data generated via electrocardiography can be used to identify a variety of heart
conditions, including:
- Tachycardia (elevated resting heart rate = >120 bpm) and bradycardia
(depressed resting heart rate = < 40 bpm)
- Arrhythmias (irregular heart beats that are so common in young people that it
is not technically considered a disease)
- Fibrillations (unsynchronised contractions of either atria or ventricles leading to
dangerously spasmodic heart activity)
6. Measure and interpret of the heart rate under different conditions, and interpret
systolic and diastolic blood pressure measurements
Cardiac output describes the amount of blood the heart pumps through the circulatory
system in one minute. It is an important medical indicator of how efficiently the heart
can meet the demands of the body

There are two key factors which contribute to cardiac output – heart rate and stroke
volume
Equation: Cardiac Output (CO) = Heart Rate (HR) × Stroke Volume (SV)

Heart Rate
Heart rate describes the speed at which the heart beats, measured by the number of
contractions per minute (or bpm). Each ventricular contraction forces a wave of blood
through the arteries which can be detected as a pulse. The typical pulse rate for a
healthy adult is between 60 – 100 beats per minute.

Heart rate can be affected by a number of conditions – including exercise, age,

disease, temperature and emotional state. Additionally, the body will attempt to
compensate for any changes to stroke volume with a corrective alteration to heart
rate.

An individual’s heart rate is controlled by both nervous and hormonal signals:

- Heart rate is increased by the sympathetic nervous system and decreased by
parasympathetic stimulation (vagus nerve)
- Heart rate can also be increased hormonally via the action of adrenaline /
epinephrine

Blood Pressure
Stroke volume is the amount of blood pumped to the body (from the left ventricle) with
each beat of the heart. It is affected by the volume of blood in the body, the
contractility of the heart and the level of resistance from blood vessels.

Changes in stroke volume will affect the blood pressure – more blood or more
resistance will increase the overall pressure. Blood pressure measurements typically
include two readings – representing systolic and diastolic blood pressures
- Systolic blood pressure is higher, as it represents the pressure of the blood
following the contraction of the heart
- Diastolic blood pressure is lower, as it represents the pressure of the blood
while the heart is relaxing between beats
 Blood pressure readings will vary depending on the site of measurement (e.g. arteries
have much higher pressure than veins). A typical adult is expected to have an
approximate blood pressure in their brachial artery of 120/80 mmHg to 140/90 mmHg.
Blood pressure can be affected by posture, blood vessel diameter (e.g. vasodilation)
and fluid retention or loss

Heart Disorders and Treatments

7. Outline the causes and consequences of hypertension and thrombosis
Hypertension
Hypertension is defined as an abnormally high blood pressure – either systolic,
diastolic or both (e.g. > 140/90 mmHg). Common causes of hypertension include a
sedentary lifestyle, salt or fat-rich diets and excessive alcohol or tobacco use. High
blood pressure can also be secondary to other conditions (e.g. kidney disease) or
caused by some medications. Hypertension itself does not cause symptoms but in the
long-term leads to consequences caused by narrowing blood vessels.

Thrombosis
Thrombosis is the formation of a clot within a blood vessel that forms part of the
circulatory system. Thrombosis occurs in arteries when the vessels are damaged as a
result of the deposition of cholesterol (atherosclerosis). Atheromas (fat deposits)
develop in the arteries and significantly reduce the diameter of the vessel (leading to
hypertension). The high blood pressure damages the arterial wall, forming lesions
known as atherosclerotic plaques. If a plaque ruptures, blood clotting is triggered,
forming a thrombus that restricts blood flow. If the thrombus becomes dislodged it
becomes an embolus and can cause blockage at another site. Thrombosis in the
coronary arteries leads to heart attacks, while thrombosis in the brain causes strokes.
8. Analysis of epidemiological data relating to the incidence of coronary heart
disease
Coronary heart disease (CHD) describes the condition caused by the buildup of
plaque within the coronary arteries. It is essentially the consequence of
atherosclerosis in the blood vessels that supply and sustain heart tissue.

The incidence of coronary heart disease will vary in different populations according to
the occurrence of certain risk factors.
E.g. The incidence of CHD under the age of 65 is substantially higher in indigenous
Australians (versus non indigenous).

There are several risk factors for coronary heart disease (CHD), including:
- Age: Blood vessels become less flexible with advancing age
- Genetics: Having hypertension predispose individuals to developing CHD
- Obesity: Being overweight places an additional strain on the heart
- Diseases: Certain diseases increase the risk of CHD (e.g. diabetes)
- Diet: Diets rich in saturated fats, salts and alcohol increases the risk
- Exercise: Sedentary lifestyles increase the risk of developing CHD
- Sex: Males are at a greater risk due to lower oestrogen levels
- Smoking: Nicotine causes vasoconstriction, raising blood pressure

9. Outline the use of artificial pacemakers to regulate the heart rate

An artificial pacemaker is a medical device that delivers electrical impulses to the
heart in order to regulate heart rate. Modern pacemakers are externally
programmable, allowing cardiologists to make adjustments as required.

Artificial pacemakers are typically used to treat one of two conditions:

- Abnormally slow heart rates (bradycardia)
- Arrhythmias arising from blockages within the heart’s electrical conduction
system
10. Outline the use of defibrillation to treat life-threatening cardiac conditions
Fibrillation is the rapid, irregular and unsynchronised contraction of the heart muscle
fibres. This causes heart muscle to convulse spasmodically rather than beat in concert,
preventing the optimal flow of blood.

Fibrillation is treated by applying a controlled electrical current to the heart via a

device called a defibrillator. This functions to depolarise the heart tissue in an effort to
terminate unsynchronised contractions. Once heart tissue is depolarised, normal sinus
rhythm should hopefully be re-established by the sinoatrial node.
D5. Hormones and Metabolism
Endocrine Glands and Types of Hormones
1. Explain how endocrine glands secrete hormones directly into the bloodstream
The endocrine system is comprised of ductless glands that release chemicals into the
blood to regulate body functions. A hormone is a chemical messenger that is
transported indiscriminately via the bloodstream to act on distant target cells.
Hormones are specific and will only activate cells or tissues that possess the
appropriate target receptor. The endocrine system is slower to initiate, but has a more
prolonged response when compared to the nervous system.

Endocrine Glands
Endocrine glands secrete their product (hormones) directly into the bloodstream,
rather than through a duct (e.g. exocrine gland). Major endocrine glands include the
pancreas, adrenal gland, thyroid gland, pineal gland and the gonads (ovaries and
testes). The hypothalamus and pituitary gland are neuroendocrine glands and function
to link the nervous and endocrine systems. Some organs may also secrete hormones
despite not being endocrine glands (e.g. adipose tissue secretes leptin).
2. Explain how steroid hormones bind to receptor proteins in the cytoplasm of the
target cell to form a receptor-hormone complex, and how the receptor-hormone
complex promotes the transcription of specific genes
Steroid Hormones
Steroid hormones are lipophilic (fat-loving) – meaning they can freely diffuse across
the plasma membrane of a cell. They bind to receptors in either the cytoplasm or
nucleus of the target cell, to form an active receptor-hormone complex. This activated
complex will move into the nucleus and bind directly to DNA, acting as a transcription
factor for gene expression. Examples of steroid hormones include those produced by
the gonads (i.e. estrogen, progesterone and testosterone).

3. Describe how peptide hormones bind to receptors in the plasma membrane of the
target cell and how binding of hormones to membrane receptors activates a
cascade mediated by a second messenger inside the cell
Peptide Hormones
Peptide hormones are hydrophylic and lipophobic (fat-hating) – meaning they cannot
freely cross the plasma membrane. They bind to receptors on the surface of the cell,
which are typically coupled to internally anchored proteins (e.g. G proteins). The
receptor complex activates a series of intracellular molecules called second
messengers, which initiate cell activity. This process is called signal transduction,
because the external signal (hormone) is transduced via internal intermediaries.
Examples of second messengers include cyclic AMP (cAMP), calcium ions (Ca2+), nitric
oxide (NO) and protein kinases. The use of second messengers enables the
amplification of the initial signal (as more molecules are activated). Peptide hormones
include insulin, glucagon, leptin, ADH and oxytocin.
Pituitary Gland and the Growth Hormone
4. The hypothalamus controls hormone secretion by the anterior and posterior lobes
of the pituitary gland
Hypothalamus
The hypothalamus is the section of the brain that links the nervous and endocrine
systems in order to maintain homeostasis. It receives information from nerves
throughout the body and other parts of the brain and initiates endocrine responses. It
secretes neurochemicals (called releasing factors) into a portal system which target
the anterior lobe of the pituitary gland. It also secretes hormones directly into the
blood via neurosecretory cells that extend into the posterior pituitary lobe

Pituitary Gland
The pituitary gland lies adjacent to the hypothalamus and is in direct contact due to a
portal blood system. The pituitary gland receives instructions from the hypothalamus
and consists of two lobes (anterior and posterior lobe).

Anterior Lobe
The anterior lobe is also called the adenohypophysis (‘adeno’ = relating to glands).
The hypothalamus produces releasing factors, which are released into portal vessels
by neurosecretory cells. The releasing factors cause endocrine cells in the anterior
pituitary to release specific hormones into the bloodstream.
An example of a releasing factor is GnRH, which triggers the release of LH and FSH
from the anterior pituitary.

Posterior Lobe
The posterior lobe is also called the neurohypophysis (‘neuro’ = relating to nerves).
The posterior lobe releases hormones produced by the hypothalamus itself (via
neurosecretory cells). These neurosecretory cells extend into the posterior lobe from
the hypothalamus and release hormones into the blood.
5. Hormones secreted by the pituitary control growth, developmental changes,
reproduction and homeostasis
The pituitary gland is often referred to as the ‘master gland’, as it controls the
secretion of a number of other endocrine glands. Pituitary hormones will often target
endocrine glands in other organs (e.g. gonads, pancreas, thyroid, mammary gland).

Pituitary hormones hence control many vital body processes, including:

- Metabolism (e.g. TSH activates thyroxin)
- Adult Development (e.g. LH / FSH trigger puberty)
- Reproduction (e.g. LH / FSH control menstruation)
- Growth (e.g. growth hormone promotes growth)
- Equilibrium / Homeostasis (e.g. ADH and water balance)

6. Some athletes take growth hormones to build muscles

Growth hormone (also known as somatotropin) is an anabolic peptide hormone that
stimulates growth. It acts directly to reduce the formation of adipose cells (i.e. less
 nutrients stored as fat). It acts indirectly via insulin growth factor (IGF) – produced by
the liver – to increase muscle mass and bone size.

Due to its role in promoting growth and regeneration, it is used by some athletes as a
performance enhancer. The use of human growth hormone is banned in sports, with
proven cases of doping strictly punished. Traditional urine testing could not detect
doping, which historically made bans difficult to enforce. Recent blood tests can now
identify between natural and artificial variants of growth hormone

Lactation
7. Control of milk secretion by oxytocin and prolactin
The production and secretion of milk by maternal mammary glands following birth is
called lactation. It is predominantly controlled and regulated by two key hormones –
oxytocin and prolactin.

Prolactin is responsible for the development of the mammary glands and the
production of milk. It is secreted by the anterior pituitary in response to the release of
PRH (prolactin releasing hormone) from the hypothalamus. The effects of prolactin are
inhibited by progesterone, which prevents milk production from occurring prior to
birth.

Oxytocin is responsible for the release of milk from the mammary glands (milk ejection
reflex). It is produced in the hypothalamus and secreted by neurosecretory cells that
extend into the posterior pituitary. Oxytocin release is triggered by stimulation of
sensory receptors in the breast tissue by the suckling infant. This creates a positive
feedback loop that will result in continuous oxytocin secretion until the infant stops
feeding.
D6. Transport of Respiratory Gases
Lung Tissue
1. Identification of pneumocytes, capillary endothelium cells and blood cells in light
micrographs and electron micrographs of lung tissue
The inner surface of the alveolus is lined by a special type of alveolar cell called a
pneumocyte
- Type I pneumocytes are very thin in order to mediate gas exchange with the
bloodstream (via diffusion)
- Type II pneumocytes secrete a pulmonary surfactant in order to reduce the
surface tension within the alveoli

Alveolar air spaces are surrounded by a dense network of capillaries, which transport
respiratory gases to and from the lungs
- The capillaries are located close to the pneumocytes and are composed of a
very thin, single-layer endothelium
- The capillaries transport oxygen within red blood cells, while white blood cells
may extravasate into the lung
The O2 Dissociation Curve and CO2 Transport
2. Oxygen dissociation curves show the affinity of haemoglobin for oxygen
Oxygen is transported throughout the body in red blood cells, which contain an
oxygen-binding protein called haemoglobin. Haemoglobin is composed of four
polypeptide chains, each with an iron-containing heme group that reversibly binds
oxygen. As such, each haemoglobin can reversibly bind up to four oxygen molecules
(Hb + 4O2= HbO8).

As each O2 molecule binds, it alters the conformation of haemoglobin, making

subsequent binding easier (cooperative binding). This means haemoglobin will have a
higher affinity for O2 in oxygen-rich areas (like the lung), promoting oxygen loading.
Conversely, haemoglobin will have a lower affinity for O2 in oxygen-starved areas (like
muscles), promoting oxygen unloading.

Oxygen dissociation curves show the relationship between oxygen levels (as partial
pressure) and haemoglobin saturation. Because binding potential changes with each
additional O2 molecule, the saturation of haemoglobin is not linear.

Adult Haemoglobin
The oxygen dissociation curve for adult haemoglobin is sigmoidal (i.e. S-shaped) due
to cooperative binding. There is a low saturation of haemoglobin when oxygen levels
are low (haemoglobin releases O2 in hypoxic tissues). There is a high saturation of
haemoglobin when oxygen levels are high (haemoglobin binds O2 in oxygen-rich
tissues).
3. Fetal haemoglobin is different from adult haemoglobin allowing the transfer of
oxygen in the placenta onto the fetal haemoglobin
Fetal Haemoglobin
The haemoglobin of the foetus has a slightly different molecular composition to adult
haemoglobin. Consequently, it has a higher affinity for oxygen (dissociation curve is
shifted to the left).This is important as it means fetal haemoglobin will load oxygen
when adult haemoglobin is unloading it (i.e. in the placenta). Following birth, fetal
haemoglobin is almost completely replaced by adult haemoglobin (~ 6 months
post-natally). Fetal haemoglobin production can be pharmacologically induced in
adults to treat diseases such as sickle cell anaemia.

4. Analysis of oxygen dissociation curves for myoglobin

Myoglobin is an oxygen-binding molecule that is found in skeletal muscle tissue. It is
made of a single polypeptide with only one heme group and hence is not capable of
cooperative binding. Consequently, the oxygen dissociation curve for myoglobin is not
sigmoidal (it is logarithmic). Myoglobin has a higher affinity for oxygen than adult
haemoglobin and becomes saturated at lower oxygen levels. Myoglobin will hold onto
its oxygen supply until levels in the muscles are very low (e.g. during intense physical
activity). The delayed release of oxygen helps to slow the onset of anaerobic
respiration and lactic acid formation during exercise.
 5. Carbon dioxide is carried in solution and bound to haemoglobin in the blood
6. Carbon dioxide is transformed in red blood cells into hydrogen carbonate ions
Carbon dioxide is transported between the lungs and the tissues by one of three
mechanisms:
- Some is bound to haemoglobin to form HbCO2 (carbon dioxide binds to the
globin and so doesn’t compete with O2 binding)
- A very small fraction gets dissolved in water and is carried in solution (~5% –
carbon dioxide dissolves poorly in water)
- The majority (~75%) diffuses into the erythrocyte and gets converted into
carbonic acid

Transport as Carbonic Acid

When CO2 enters the erythrocyte, it combines with water to form carbonic acid
(reaction catalysed by carbonic anhydrase). The carbonic acid (H2CO3) then
dissociates to form hydrogen ions (H+) and bicarbonate (HCO3–)Bicarbonate is pumped
out of the cell in exchange with chloride ions (exchange ensures the erythrocyte
remains uncharged). The bicarbonate in the blood plasma combines with sodium to
form sodium bicarbonate (NaHCO3), which travels to the lungs. The hydrogen ions
within the erythrocyte make the environment less alkaline, causing haemoglobin to
release its oxygen. The haemoglobin absorbs the H+ ions and acts as a buffer to
maintain the intracellular pH. When the red blood cell reaches the lungs, bicarbonate
is pumped back into the cell and the entire process is reversed.

Blood pH and the Bohr Shift

7. Chemoreceptors are sensitive to changes in blood pH
Aqueous carbon dioxide may combine with water in blood plasma to form carbonic
acid (H2CO3). Carbonic acid may then lose protons (H+) to form bicarbonate (HCO3–) or
carbonate (CO32–). The released hydrogen ions will function to lower the pH of the
solution, making the blood plasma less alkaline.

Chemoreceptors are sensitive to changes in blood pH and can trigger body responses
in order to maintain a balance. The lungs can regulate the amount of carbon dioxide in
the bloodstream by changing the rate of ventilation. The kidneys can control the
reabsorption of bicarbonate ions from the filtrate and clear any excess in the urine.
8. pH of blood is regulated to stay within the narrow range of 7.35 to 7.45
The pH of blood is required to stay within a very narrow tolerance range (7.35 – 7.45)
in order to avoid the onset of disease. This pH range is, in part, maintained by plasma
proteins which act as buffers.

A buffering solution resists changes to pH by removing excess H+ ions (↑ acidity) or

OH–ions (↑ alkalinity). Amino acids are zwitterions – they may have both a positive and
negative charge and hence can buffer changes in pH. The amine group may take on
H+ ions while the carboxyl group may release H+ ions (which form water with OH– ions).

9. The Bohr shift explains the increased release of oxygen by haemoglobin in

respiring tissues
The oxyhaemoglobin dissociation curve demonstrates the saturation of haemoglobin
by oxygen under normal conditions. pH changes alter the affinity of haemoglobin for
oxygen and hence alters the uptake and release of O2 by haemoglobin

Carbon dioxide lowers the pH of the blood (by forming carbonic acid), which causes
haemoglobin to release its oxygen. This is known as the Bohr effect – a decrease in
pH shifts the oxygen dissociation curve to the right.

Cells with increased metabolism (i.e. respiring tissues) release greater amounts of
carbon dioxide (product of cell respiration). Hence haemoglobin is promoted to
release its oxygen at the regions of greatest need
(oxygen is an input of cell respiration).
Respiratory Control
10. The rate of ventilation is controlled by the respiratory control centre in the medulla
oblongata
11. During exercise the rate of ventilation changes in response to the amount of CO2 in
the blood
The respiratory control centre in the medulla oblongata responds to stimuli from
chemoreceptors in order to control ventilation. Central chemoreceptors in the medulla
oblongata detect changes in CO2 levels (as changes in pH of cerebrospinal fluid).
Peripheral chemoreceptors in the carotid and aortic bodies also detect CO2 levels, as
well as O2 levels and blood pH.

During exercise metabolism is increased, which results in a buildup of carbon dioxide

and a reduction in the supply of oxygen. These changes are detected by
chemoreceptors and impulses are sent to the respiratory control centre in the
brainstem. Signals are sent to the diaphragm and intercostal muscles to increase the
rate of ventilation (this process is involuntary). As the ventilation rate increases, CO2
levels in the blood will drop, restoring blood pH (also O2 levels will rise). Long term
effects of continual exercise may include an improved vital capacity.

High Altitude Training and Emphysema

12. Consequences of high altitude for gas exchange
Partial pressure is the pressure exerted by a single type of gas when it is found within
a mixture of gases. The partial pressure of a given gas will be determined by:
- The concentration of the gas within the mixture (e.g. oxygen forms roughly 21%
of the atmosphere)
- The total pressure of the mixture (e.g. atmospheric pressure)
 At high altitudes, air pressure is lower and hence there is a lower partial pressure of
oxygen (less O2 because less air overall). This makes it more difficult for haemoglobin
to take up and transport oxygen (lower Hb % saturation). Consequently, respiring
tissue will receive less oxygen – leading to symptoms such as fatigue, headaches and
rapid pulse

Over time, the body may begin to acclimatise to the lower oxygen levels at high
altitudes:
- Red blood cell production will increase in order to maximise oxygen uptake
and transport
- Red blood cells will have a higher haemoglobin count with a higher affinity for
oxygen
- Vital capacity will increase to improve rate of gas exchange
- Muscles will produce more myoglobin and have increased vascularisation to
improve overall oxygen supply
- Kidneys will begin to secrete alkaline urine (removal of excess bicarbonates
improves buffering of blood pH)
- People living permanently at high altitudes will have a greater lung surface
area and larger chest sizes

Professional athletes will often incorporate high altitude training in order to adopt
these benefits prior to competition. Athletes may commonly either train at high
altitudes (live low – train high) or recover at high altitudes (live high – train low).

13. Causes and treatments of emphysema

Emphysema is a lung condition whereby the walls of the alveoli lose their elasticity
due to damage to the alveolar walls. The loss of elasticity results in the abnormal
enlargement of the alveoli, leading to a lower total surface area for gas exchange. The
degradation of the alveolar walls can cause holes to develop and alveoli to merge into
huge air spaces (pulmonary bullae).

Causes
The major cause of emphysema is smoking, as the chemical irritants in cigarette
smoke damage the alveolar walls. The damage to lung tissue leads to the recruitment
of phagocytes to the region, which produce an enzyme called elastase. This elastase,
released as part of an inflammatory response, breaks down the elastic fibres in the
alveolar wall.A small proportion of emphysema cases are due to a hereditary
deficiency in this enzyme inhibitor due to a gene mutation.

Treatments
There is no current cure for emphysema, but treatments are available to relieve
symptoms and delay disease progression. Bronchodilators are commonly used to
relax the bronchial muscles and improve airflow. Corticosteroids can reduce the
inflammatory response that breaks down the elastic fibres in the alveolar wall. Elastase
activity can be blocked by an enzyme inhibitor (α-1-antitrypsin), provided elastase
concentrations are not too high. Oxygen supplementation will be required in the later
stages of the disease to ensure adequate oxygen intake. In certain cases, surgery and
alternative medicines have helped to decrease the severity of symptoms.