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cordon, so hopefully we can see that. How everyone? I'm just in from the Brooklyn. Easy team on. I'm doing the second to last. Basically little sciences session for you guys today. Um, so this is what the session involves. It's taken from the pieces three curriculum at Cardiff and self hope. You guys enjoy and hope you take something away from this session. So we'll get right into it, starting off with purpose and ask me again. I've taken these better points from the piece of ST checklist and so I hope hope of cover most important parts. One thing I just want to remind everyone is a revision session. So I'll be looking at, like, the most important fits to this the hip. It's to these content. So, uh, I hope it's, um I hope you have, uh, take take something away from this is well, so again, starting for siding with pelvis and after me eso again. The key points the pelvis in after me. The pelvis is made up off to hip bones. And if you're a part of the sacred all birch well column on but they're held by the pubic symphysis anteriorly on then the sacred iliac joint Posteriorly. There's a pelvic cavity is a big angle under the abdominal cavity. So as you see in the diagram, there's three abdominal cavity and then facing a little bit forward, it's a cavity. The floor of the pelvic cavity is formed by the elevator, and I, on the coccygeus on the floor, is perforated by the urethra. A look now on females that the vagina as well. On the quite important concept, the space below the pelvic diaphragm is known as the perineum. Um, and so looking at parent him, uh, the the number name could be used for, as we said, the shallow paraneal compartment inferior to the perfect diaphragm. But also it's the external surface between the proximal parts of the thighs. So looking at the key parts, the things that you guys need to know is that the parent here is the diamond shaped space below. The pelvic floor muscles between the eye at the perineal borders are as follows. The pubic symphysis anteriorly the tip of the Cox Cox sick posteriorly They're natural. Naturally, the issue of pubic Ramus on the sacred fevers ligament on do the perineum can then further subdivided by this translates this imaginary line between the issues and Rosty is and so if that's important, we're gonna look at the two triangles coming up. But first, I just want to get you guys engaged, right? First off. So starting off with a question I have Could I ask you to stop the pole, please? Sorry. The question. The nerve that supplies the nerve that supplies most of sensation to the extra external genitalia in men and women also provide motor supply to the public floor muscles and external anal sphincter. What is this nerve on what? Our It's enough fruits. So I really wish that everyone gets involved. So even if you don't know the answer, just have a stab it. He has the a few seconds on this one. I can't see who's answering, So don't be a mass. It'll it's just just have a little little attempt. Uh, we got more plants, you know? Very nice. So, yeah, people are low looking at the right answer. Um, I think we'll call it there. Thank you. Have, um and so it Yes, the answer is See the potential Know that the nerve roots are s two s three s four. So, um, looking at perineum a little bit further, it's split into those two triangles that he talks about the Urogenital triangle. A little angle on most important things I want you to stay away from. It is the contents of each triangle. So the you're gentle triangle that contains the urethra opening that vaginal opening and females, as you said on the paraneal membrane, which is just a tough fascia that provides attachment points for the external genitalia muscles. And the triangle obviously contains the A lap achier located centrally on surrounded. Surrounding that is the external anal sphincter. Either side is the issue a dull foster which too fat fields faces on, um, around around. That is the little nerve that comes through, the less static for a minute, you can see there. So again, another important point is the dental nerve. And it's innovation. It's both sensory and motor on the the way. I want you to remember Sorry the way I want you to remember. But until now is s two s three s four keeps your off the floor, so I hope everyone groan of that quite nicely. Demonic. Um, so and I had nice little rhyme, Onda said. I'll let you guys be through a specific sensory and other innovations, but I'll move forward. Uh, so looking at female anatomy s So this is a This is a sagittal plane. Everyone loves the diagrams. Eso Starting off, we have the uterus, which is found pasta posterosuperior to the bladder. So on top, off onto the back of the bladder, um, is at an anti voted angle to the vagina on D, but it can lean against the rectum, and so it could be retroverted. There is another important thing I want you to take away for both male and female. The general rule is that the you're gentle system is located anteriorly more to the front on the digestive system. More posteriorly now with the uterus of it. For females on what you get is the peritoneum, tightly covering the top of all the structures on. So from this, you get certain pouches or certain indentations. Almost so is you can see there's a Hopefully, the line shows there's the power trip, Douglas. So that is the part of Douglas is the most inferior part of the parent. Put Paratonia old cavity on it's known as a dependent area. This is basically where, like pass on ascites can collect ascites or just fluid from the abdomen on. But, um, this is relevant for you guys because a second see it lies quite close to the vagina. And so surgically, this quite advantageous, because we can drain the fluid from my perforating through the vagina rather than going into the cavity. And so that's that's one born Paps. As we said, the rector, he trying pouch. There is also the Visa Co uterine pouch, which is labeled out. I think of showing it there. It's just a pouch for my bladder and the uterus. Another quite important thing for us take away is that the you trying to be actually open into the peritoneal cavity on this is relevant for you guys. If yours, it potentially provides a pathway for female that the foot for the female jump it genital tract on the abdominal cavity. And clinically, this is relevant because if there's an infection or a Ninfa, a shin from the vagina uterus or even the you trying to this consult in it. There's a result of an infection in the paratonia as well. This is known as parents like this. Look at the male anatomy. They're important parts being there's that there is another power form director of musical pouch on. Also, Another thing you guys need to know is that the meld you re throat is 18 to 22 centimeters long versus the female 4 to 6 centimeters long is important when it comes to capitalization. When you're inserting a tube through the urethra to access the bladder, when there's, um, your urinary retention on go, you just need to know that with the male urethra, right, it's quite complicated, as you can see due to the different regions and the length on so procedures just a little bit more complex. Another important structure that I want to highlight is the prostate, and I ask the same question a few months of process as well. But no, it's only may last that you'll find a prostate on, but the location is quite relevant for you guys as well, because if you ever want Teo examine the prostate, you can, and as you can see, it's quite close to the rectum. And so what you can do is entered through the rectum and you can examine the prostate gland, which is just a walnut sized gland. With two lobes on, you'll be able to feel it is quite firm. And so that's how you examine the prostate moving on. So yeah, there we go. Director Musical pouch Move forward with a female reproductive anatomy. This's quite busy slide that I know, I know, you guys old love. Um, I know you guys love diagrams, but I am with anatomy. There's no better way to revise it other than yourself. One second. Sorry, Scott, Better cough. Yeah, it's a better way to revise, other than looking through it yourself, but obviously I want to focus on the quite important points when it comes to then at the side. So starting off with the starting off with you to, uh, you're trying to It's split into the fimbria, the infundibulopelvic ampulla. This is muscle on the intramural part on the intramural dissenters. The is a part of enters into the uterus, the uterus. The next important point is the layers off the uterus and the muscle layers, theand, amitriptyline, myometrium and the most out of partying. The Parametrium, also known as the cirrhosis. This is just a smooth outer layer derived from the peritoneum. It's kind of considered Mistral peritoneum. Um, Andi, another thing you should focus on is the broad ligament. The broad ligament is to the layer of tissue that connects the sides to the sides off the uterus walls on the floor of the pelvis. That kind of puts it in place. It covers the uterus, the ovaries and the fallopian tubes. Um, again, you're gonna revisit this in case four. So if even if I'm going through a little bit quickly, you guys, to have these slides flip through. But again, the important parts to know these little this specific structures and their function um, the next important point actually focus on is theseventies Cervix is split into two main parts, the the entrance of service. And so, as you can see, you have the endo cervix on the Actos cervix. On the end of cervix is the part that leads it leads into the canal into the uterus. It's made up of simple columna epithelium or grant glandular. A medium on the function of this is to secrete mucus. The exercise of X is the outer part of the cervix and it's it's rounded, and it's a little like structure that sticks out into the vaginal canal. It's covered by squamous cells on. The function of this is to protect against abrasion. So when you again, the tip I have for you guys when it comes to anatomy, when you do learn and asked me, just try and learn it with structure with function. Eso As we said, the end of cervix is for mucus secretion to form the mucus plug on, then the Actos cervix is for protection against abrasion from from penetration, all from from anything else. Really, the clinical significance with the cervix that you guys need to know it is. There's an area within within their their air. It's called the Transformation Transformation Zone, and it's basically when the actor cervix becomes the under cervix on this is this is an area that's most common for abnormalities to form, where cells can develop abnormal, have no abnormally. And so there's a thing in the chest, a pap smear test that females are advice to every three years on. It's just to test the cells that area to make sure there's no abnormalities on guess the final thing is the for next that's formed by the cervix in coming out into the vaginal canal. The phone in the pharmacies. You can feel you can feel for them in a vaginal exam mission as well. And that's it's just it's just a system, Um, a little invitation, almost that's there. Um, took a moving on way, have external genitalia. Once again, I'm just going to focus on the key parts here, and we'll leave these diagrams for you to revise. I think they want to go. I want to focus on is the best of you'll. I don't think this is clarified for me. So that's why I'm telling you, guys, the vestibule contains the urethra opening in the vaginal opening on it's encased by the labia minora, um on then when the mail and asked me, Obviously, the Penis. It contains the two it contains to corpus cavernosum that engorged blood during erections on the one corpus spongiosum on. This is the structure that contains the urethra. Another thing I want us take away is thie, that erections are controlled parasympathetic Lee. So I would have always thought it would be controlled sympathetically excitation all of this. But no, it's not fight or flight. It's actually resting digest, but I guess And easy way to remember this. Is that erections? A passive the parasympathetic controlled. So if you if you just take Oh, procreate is just a little Brian. So I came up with Sorry s o moving forward with abdomen. Asked me again taking this from pieces three. Uh, So first I want to start with freshly. I thought was question there. Just test you guys once again, this is PCs to knowledge. Hope. I hope you guys No, no, the answer's yes. So let me read out for you guys. The arterial supply of the abdomen comes from three vessels. Which of these resupplies thie Upper gi tract. So, um, with this question, I think, um, yeah. So you guys getting it? There's I meant the three supplies as, um, there's there's three sections to the GI tract. The, um, the four gut, the mid got in the hind gut. Um, I should have named it like that. That's my bed. But I think you guys getting actually used your I do send any answers. Um, yes, everyone, everyone is one is answering correctly. It's a few more people will give you a few more seconds on. I guess we'll call it there. Thank you, guys. Thinking of, um So, yes, The answer is he the the celiac trunk. So the three vessels that we were talking about are the celiac trunk, the superior mesenteric and the inferior mesenteric. Um and so we're gonna fall. So I just added this diagram. Thank knish for ah for providing this diagram. It just gives you an overview of the celiac trunk supply of the the upper GI tract. I just want to focus on a few things from this on the two. The two key things I want us sick from This is the diaphragm on the openings in the diaphragm. So the CT trunk comes from the, um, comes from the aorta on. So you guys need to know the specific openings on the way to remember it is each of the openings of indicated this soft dressing there aortic hiatus. The number of letters in the in those words are corresponds to the level at which they enter through the diaphragm. So vindicated a letters they enter t eight a softer deal. Unfortunately, spell American. It's not suffered your hiatus into that t 10, because as 10 letters and aortic hiatus, there's 12 letters Onda to remember the guy from innovation. It's the Phrenic nerve on different nerve comes from C three, c four c five, because it keeps the diaphragm alive. And so that's how I want you to remember it. But I added these out of the steroid drops for completeness. But what we're going to focus on is the portal be in the system. So, um, first of all, I just want to tell you guys the venous drainage of the abdomen split into two kind of parts. There's the systemic on. There's the portal venous system. On the systemic is where is the inferior Medical Vienna Cavor Collecting blood from the comedy Act. Veins, which drains the lower limbs and part of the pelvis on the portal venous system, have a collect blood from other places. The three main kind of groups. There's a splenic vein. There's a superior reason Terek Pain on. There are some other ones as well, but the two of us focus on the splenic and superior mesenteric and from the splenic it's this back pain also collects blood from these other veins as well, most notably that inferior mesenteric on. So the superior mesenteric also collection the's tributaries as well. The important thing is just recognized that the portal vein does collect so similar to how the abdomen is supplied by the abdomen supplied by the celiac trunk. The superior mesenteric on the inferior mesenteric. The portal vein also collects from those three. But the inferior mesenteric empties well collects into the splenic pain before he enters the portal vein on I added this diagram just to show you guys the the, um so blood for the blood circulation of the body. And just to show you that the portal vein isn't actually a true vein, it doesn't empty straight in the heart. It goes through there. It goes through the liver first and but moving forward. What is the clinical significance off knowing that sport of being a system on its to do with portal systemic and asked emotions? So I first had estimated when I was studying. That sounds a bit like what? Ah, into sounds bit like it sounds like probably it sounds like something wrong with the body, but no, actually, nasty Moses can occur naturally in the body, but they can't be created surgically as well. And so this porter systemic lastimoso is is a connection between the veins of the portal and systemic being assistance. So what can happen with the portal system is is that it could become become obstructed, and it can be obstructed by various causes. Cirrhosis PPT on external pressure from a tumor. Um, but when the blood flow is obstructed, the pressure then starts to increase on. But you could see their pressure of over 20 millimeters of mercury is notice portal, hypertension. And so, with portal hypertension, what could happen is blood gets redirected through the port. Oh, systemic anastomosis on. Do with this. This system is usually things. And, uh, so is this is usually under low pressure. But over a long time, with a large volume of blood, what could happen is there. After Moses, the veins and the anastomosis can dilate on these cause Barris is or viruses. These viruses are fine, but they what What can happen. What could potentially happen is a rupture which could be two fatal blood loss. And so that's the importance of this complicated system that portosystemic ask the movies moving forward looking at the biliary tree on the pancreas anatomy about this about this diagram for completeness once again. But the thing I want you to take away from this other ducks and how they come together. So first of all, the right and left about it that form the common hepatic duct. They come together to form the common hepatic duct when to look something up, usually named common. So you you'll see that coming up. The common hepatic duct is then joined by the cystic duct off the gold bladder, then that but then becomes the common bile duct. The common bile duct is joined by the pancreatic duct. On this enters to the second part of the two of them They enter through system through a structure called the sample of barter. On. This had a whole almost is control. The opening is controlled by the sphincter body OD on. So why is important for you guys now is just to know the just you know, the ducks and how they what kind of structure they form it What? How were they entered to do that um, when you guys get onto case six, the liver case, you're gonna you're gonna see stuff like jaundice and prehepatic person. Batic Onda about a jaundice as a week. But the importance of knowing the tree is just to know where structures or blockages could happen, or possible cancers can occur. So that's why it's important for you guys to know this last me. Now, looking at the pancreas, pancreas is a pretty cool organ. In my opinion, it's a glandular organ and that you probably will know it has exocrine and endocrine function. So digestive, a hormonal, the pancreatic duct, as we just said, choices with a common bile doctor from the hepatopancreatic um, pelo barter very, very much a mouthful. But the thing I want you to take away from the pancreas is the part of the pancreas. So with the pancreas you have the head, which is the widest part, and it lies in the C shaped curve off the do it at home. Um, it's connected to the do it in, um, by a connective tissue as well. That's the other thing you need to know. There's this structure called there. With that, there's a part called the Unconnected Process. Hope announcer. I think I Googled that earlier. I think that's how you pronounce it. This is just a projection that arises from the lower part of the head on, but it lies posterior to the slides behind the superior mesenteric vessels. More importantly, the neck between the head and the body, it overlies the superior mesenteric vessels, the body of the body off the pancreas. A little bit more importantly, life centrally. So if you do a midline down the body, it would be located that on it lies behind the stomach on down to the left of the superior mesenteric vessels on. Finally, the tail of the pancreas lies in close proximity with the hilum of this place, and now we've come to the left part of the body. They left part of the abdomen. Sorry on. The important thing to know is that it's it's contained within the Splenda renal ligament, which is the ligament that connects their speed on the kidney on Do. Another important thing to know is that the tail is the only part off the pancreas that is intraperitoneal. So that's another key fact that you guys need to know the rest of the body is retroperitoneal, but the tail is interest paratonia. And so this gives us a nice Segway into a next part of the kidney and at me physiology and asthma regulation. So starting over the question obviously, always do. Just just to make sure you guys are still with me eso I'll read the best Now intraperitoneal organs are enveloped by risk group aritomi. Um whereas retro peritoneum organs are only covered by a parietal peritoneum on the anterior surface Lot of peas. Which of the following is a retroperitoneal organ? Thank you dot So again, I would really want to see full participation. Even if you don't know it's one everyone to give it a go. Um, again, I can't see who's answering, so just give it a go, guys. Okay. And again close. So they I'll I will say this is pieces too. So if anyone was lot of pieces, so this is just a little bit of a recap there. Just see if he has remember here. Okay, give it a few more seconds. I think that there's a bill that there's a bit of ah, righty, but most people again the right answer on end of that pack. Thank you. Um and so the answer is it is D It is the adrenal glands. So I threw you guys off a little bit, not really threw you off, but I think the reason I brought this up with just so it is the thing I do is well around revising these demonic. So I'm pretty sure everyone knows this demonic, sad packer. It's the new monitor. Find that it's the new. It's a new like that shows the retroperitoneal organs problem as you learned the name on it. But then you forget to learn what they actually mean. So don't forget that the essence sat back. A is super super renal. So we're gonna look at that what that means. But that's where the adrenal glands sit on the A is actually aorta, but also in three ivc the fear of Benicar for so the point. My point is just when you do learn these Monets, don't forget to learn those exceptions and also like specifically what they mean. But everyone who got that right very well done. I would go that route, but very nice. It was the adrenal glands. So now we're going to look at the kidney. So something after the fact that the kidney kidney's light retroperitoneal as we saw Sad packer. They die between 12 and L3, but the left kidney being a little bit higher. The dream of land sit on top is you can see right there, um, supplied by that supplied by the renal arteries and every no veins on. It's the ureter that connects the kidney to the bladder, and so that's an important point. It's not the urethra, it's the ureter, So the urine taken X kidney to bladder urethra. It connects the bladder to the body's exterior, allowing urine to exit. Um, so why is it relevant to you guys the clinical application of this? So you might get a patient coming in with thing called flank pain? Flank pain is like it's just a never This is an area of the back on your back where the kidneys would be so you might be asked to do a kidney palpations. It's called ballot balloting. The kidney. That's the technical term for it. So how you balance the kidneys you guys can see is you place your hand below and above the, uh, where the kidney would be. It ask the patient to take a deep breath in on when they were. They take the person when they take a breath out, you start palpating from above and below on in health. You should actually, so when you probably you shouldn't feel anything in a normal person. But in pathology, you might feel that their kidneys, a large dose, it might be hardened. Or, you know, that pain on that is the clinical application of nowhere where specifically, the kidneys are, um, very forward with the internal kidney anatomy. So I guess our big going smaller is water. So looking at internal kidnapped me. There's a lot of structures within this within the kidney, but I'm gonna focus on the most important parts. So starting with a renal capsule, it's just a thin. Remember it. Remember the sheet that covers the outer surface of each kidney we have. The real cortex provides a space for arterials and Daniels from the renal artery and vein to that's what that's what they are. We have the reader, Medalla or Medalla, which regulates this is the area that regulates construction of urine, and we're gonna get into this a little bit more. We have the renal pelvis, the enlarged upper end of the ureter, and of the ureter coming off there on. Then you have all of these other smaller structures I'll let you guys look into, but that these are the key parts. Um, okay, this slide is very busy on I've got tell you from the slides are getting busier, but I don't want you guys to hold on with me a little bit. I think so. We're going to start off with the nephron. So the nephron you can see some keep keep parts of the nephron are the Afrin arterial coming in, enters the Amaryl a cat. The capsule on this is where blood gets filtered. The filter is then taken into the proximal convoluted tubule. You gotta take note that this is all this is all within the cortex on then. At a certain point, the proximal convoluted tubule becomes the ascending loop of the ascending loop. Sorry, they did the descending loop of Hendley on that when it enters the meddler, then rise up being ascending loop of Hendley and then enters the cortex. Once again. Here it becomes the distal, convoluted tubule and then multiple distal comedy to two pills Cut, connect to become the collecting ducts. And so another thing I need I want you to take away is thie the bars Erector And the director is the parent to the peritubular capillary network that almost in case is this a different system? So another notice that it comes off from the Afrin e that the different arterial from the glomerulus looking at the glomerulus a little more specifically and add two more labels s a starting off with the myositis in the arterials. They they basically in both arterials that basically has enabled are you also contract and this change of the flow of blood and then effectively the BP within the the Flamera. Let's go look at this a little bit more later on. But effectively control filtration and filtration rate. There's the juxtapose Maryland cells that lie in that almost that junction. The's also known as granular cells that synthesized store and secrete the enzymes, Renan, And again, we're gonna look at that a little bit more as well. The distal completely to tube. So you think why is it like coming back around The proximal convoluted tube takes away the filtrate. And then it kind of goes through our whole system, and then it comes back around. So you can see that this so convoluted tube allies in close proximity to that junction again, that arterial junction. And the reason for this is they contain they could Then these cells called maculate answer. And these are really cool cells that I think they're quite called. They play a key sensory and regulatory function in maintaining blood fluid. Sorry, body fluid, electrolyte homeostasis. And also, they are able to detect this. This whole apparatus is is able to attack the smallest BP changes. And so I just made a note of we'll look at that, more specifically coming up. But this is just where that it'll is the policy and stuff. We're gonna look a little bit more eso Yeah, little Marylise. I've made a note off the what could be filtered through but looking a little bit closer at the glomerular basement membrane. Um, so I'm gonna put all those notes out again. I will let you guys read specifically into that in your own time, But The key part of this is the three parts of the basement membrane. You have the basement membrane itself that is acid. So this whole, this whole system access of filter. They work together to filter specific salutes and irons and stuff. So it started with the basement membrane access filter because it's charged on day so the memory is negatively charged. This prevents negative ions from leaving the blood, Um, with the basement membrane eso with the fenestrated and the fetal cells that the important thing is that fenestrated part. And it just means there's holes in the end of the remember in the individual cells, these actors windows allowing fill filtrate to get through the movement of water ions. And then you have the policy type, which ultimate provides, like a barrier with slit in between the foot processes on. This prevents plasma proteins entering the unit of urinary UltraFiltry. So UltraFiltry is just again, just another word for the filled the final filtrate that comes that is filtrated from the blood moving forward. So now a little bit mass. Don't shut up for me here, but we'll keep working on going with this so the G F r The Glomerular filtration rate. What is it? Sideways It It's basically the volume of blood filtered by the glomerular capillaries per unit of time on, there are three facts out that term in the far. So as you can see, you have blood flowing in from the Afrin arterial into the capsule in the capillaries. You you. So this. With this incoming blood flow, you have the first determining factor, which is the hydrostatic pressure. And this is just This is basically the pressure of the incoming fluid or incoming blood on this promotes filtration. So this is, um, it says you can see this works against the bones capsule pressure. So obviously the incoming pressure from the blood. But then, obviously there there will be a pressure acting against it forces opposing forces almost. And so the Romans capsule pressure a Z Well, as the oncotic pressure works against this, I don't hydrostatic pressure. The pressure is always is on. Chronic pressure is also known as the colloid osmotic pressure. It's basically the it's when it's it's a pressure that's formed because the blood contains a lot more higher concentration of proteins. And so it's the tendency for the water to move back in and that this forms of pressure and so what you can get from this is the net filtration pressure on this is formed, went this is that you can get this is not formed. You can work this out by taking one away from two away from three. And so, with the natural tritium pressure, you can work out the G f r the G fro to work out the fire. You need thing called the K f. I'm always KF it's the ultra filtration coefficient on. Did you see that? It's It's a constant determined by hydraulic properties, surface area and thickness of the membrane. So again, important things to take away is that there's this incoming pressure hydrostatic pressure from the blood flow. There's a supposing force from the moment capsule itself on. Then there's that colloid a small tick pressure on. We're using those figures. You can work out the net filtration pressure times that with the K F and you can work out GFO again. I'll let you read through those extra notes in your own time, but we can't have a mass teaching without mass question, so I hope I haven't get everyone's participation on this power. If you could sell the pool again, so I'll be this question out in healthy GFI is approximately 100 25 mL per minute, using information above. Calculate the chaos. So remember it's g f r is the KF times by the net filtration pressure. So you need to work out the net filtration pressure and then find the calf. I'll give you a little bit on this one, but not too long. Okay? Again, please. I want to see everyone's participation. It's just nice to see everyone involved. Doesn't matter if you get the wrong answer. It's just about having participated. It's very good seeing a lot of right answers. Okay, give it a few more seconds and everyone's getting out that calculator, dusting it off. Do you get ready for Because on a card for anyone with exams of January, you will need a calculator. So how about when you, um just a practice? Not in the athletes. Okay, so we call it there. Thank you. Thank you. Power s so we don't get most people get in the right answer. It is 12.5. So as I said, working out the net filtration pressure. You minus the hydrostatic pressure from the capsule pressure minus the oncotic pressure. It gives you 1025. Divided by 10 gives you the chaos. Um And so another question I didn't I forgot about this. There's another question. Okay, reading this, I'll read this one out. The Afrin and the front arterials are linked with my sites that control the diameter of the liver. This regulates the volume and blood of the pressure of blood in the glomerulus. Which of the following will result in high GF are so it's gonna take. I know this's the concept I was going to describe to you guys now, but when you guys having attempt at it, see if you're asking Good idea on it again. Just even if you click around about Just wanna see participations as many people involved. Always nice to see very well done. You guys are getting the right few more few more seconds on this. Then I'll go through the through What? The white. Okay. Few seconds. Few more people just to make sure you guys are still they're saying. Sure. You guys are so listening. Mm. okay. Problem? I think we'll call it that. Thank you. So people went for be on the right. Answer is it is be very well done. And so why is this? So with the glomerulus, the one second with the Marylise, the basic science of it is Did you have as we said, we have this incoming. Let me try and go back on seconds. Um, they're here. You have this incoming pressure. You have this incoming blood which comes with the flow of BP. You you can, as we said, there are my sights within the arterials that control the thing. The Lumen diameter stick can contract and according to the smaller or loose and relax to make it bigger. The answer was Afrin arterial with high diameter compared to the even arterial, which has a lower diameter on. The reason for this is if you think about like your arteries contracting. You want that you want When you contract when blood is flowing, this almost looks like backlog of blood. And so what you want is blood to have spent enough time in the in the capsule to be able to filter out everything that he needs to fill. Try the soldiers and everything, and so if you have a it's no, it's not an increased diameter because if you have an increased amateur, there's a decrease in blood pressure. But it's just a higher diameter compared to the full arterial theophylline. Arturo will have a higher diameter, which allows more blood in on when the blood is in the capsule on. But it tries to leave through the even arterial. There's there's there's this backlog of blood on. Then it effectively means, um, the hydrostatic pressure that really important on that first one is increased. You get this backlog of pressure increasing the pressure on it, increasing the time that the blood spends within the capsule within the capillaries of the capsule. And so that's why hire. That's why that is, that combination off diameters will give you a high IgE fr because it increases effected increases. The glomerular cap capillary hydrostatic pressure on that increases the gel form. So moving on, quite important concept reabsorption that secretion. So this is what we didn't talk about the kidney. How it functions is the left one and all of this. How it functions is through filtration. Then re absorption secretion and then it excretes a filtrate. So what is reabsorption stuff? Because you can use these words, but you know how to use it. Specifically, the reabsorption is the movement of water and salutes from the nephron to be back into circulation. So why that's abortive Noticed? It's reabsorption is basically us taking back. The important I owns and Soviets that one from the nephron, which has filtered out back into the blood secretion, is removing any anything that we don't want from the blood from circulation back into the nephron to Bill. So we are looking at a lot of tubes and circulation, all of this, but I want you guys to focus your mind on what we're specifically take it in. Throwing out this next diagram is quite busy. I know this is just an overview, so I'll let you guys look at it more specifically in your own time. But a few of the important things I want to focus on is the different parts of the net front on do the what what is basically re absorbed on secreted. So it's important that we use the correct terminology. So I think the first important point is that the ascending to bill so the one go back up there. Sending tubal of the loop of Hendley is impermeable. The water on domain water results and explains in the descending liver, as you can see right there on, so what is effectively does is in the descending limb. When waters result back into the blood, you get this increased concentration of ions for the ascending limb off the nephron on go, Then this allows easier transporter, easy diffusion or movement off irons that we want back into the blood. So that's what That's why you can see that the sodium fluoride island potassium be sending limb. It is taken back in to the blood. Another important thing to note is that it's at the p C. T. That the creatinine drugs on day How's your bones are secreted again, put into their phone on, then excreted later on. It's excreted through the collective darkened like conducting outwards. So I'm gonna give you is a pre warning. The next few slides can be it's gonna look a little bit daunting, but I'm gonna go through it together. It took me a lot of times, well, toe understand what I was looking at here. But bear with me, we'll get through it. So, looking closely, the physiology now each section we're gonna look at the proximal convoluted to first. So first, I think first molecule that we want to resort back into the blood is Blue Cross. And also also, I mean, I said that follows the same kind of transport. So how can we get glucose from the Lumen off the proximal convoluted to the p C. T back into the blood and it And it does this by a sodium glucose co transporter. So what you get is a sodium ion, um, ganglia transported with the glucose. If any of you guys join me with my pieces one, uh, revision session you guys were known we had looked at different glucose transporters. This is a specific one that we looked at called the S thesis odium dependent Lucas transport at the SGLT two very specifically. So that that transported there is the SGLT two. So what it does, it's involved in effectively because reabsorption in the kidney. So from the Lumen the glucose has taken up from the cell. It can result back into the blood from eso. Another eye on that one is the sodium. So yes, sodium be taken up through this glucose transporter. But it's also taken up through this sodium hydrogen ion anti border, so sodium is taken in from the Lumen into the cell on. Then what can happen is it enters the bloodstream fire the sodium potassium pump and the pump because it's ATP dependent. And so, as you can see, the sodium is, it can enter the blood. It can enter the cell in multiple ways and then enter the blood via that sodium potassium pump. That so those are something important Concepts The next conservationist explain to you guys is quite important. And I really need You got steak? I will. We'll take our time with this. One is very important when you're gonna look at this in case three when it comes to blood gases on. But what we're gonna look at is the regulation of blood pH uh, from the kidney. So as you can see right there, there's a hydrin. I am being being transported back into the Lumen. What can happen is it reacts with bicarbonate in the Lumen, which can then form hydrogen bicarbonate on through an enzyme called the carbonic Anhydrase. It conform water and Syria, too. Okay, so bad with me. What happens then is the water and see what you can enter the cell and then go to and then dissolve into the blood. So ask you guys to tap into a little bit of a level of the chateau. Really expensive. All there were reversible reaction, a little bit equilibrium. To try and happens are kind of knowledge. What's happening here is, as you can see, that that first system the bicarbonate reacting with hygiene ion, then eventually forming water issue, too, is, ah, equilibrium reaction. When I see you to enter the blood, you get this shift in so two concentration on. If you remember, equilibrium shift is an equilibrium system. It's a very fine system when when there's increase in Syria, too, then causes increase in hygiene, iron concentration on. So what happens then is a decrease in peak age, and so the blood acidity goes up effectively, the bone becomes more acidic. So how come you counteract this Similarly, as we can get hates doing so to be get bicarbonate again on the bicarbonate, It can be transported into the blood, and this is via a sodium dependent bicarbonate transporter on go do Make note of that. That's important. So in the p C T, there's a sodium bicarbonate trying to get a sodium dependent bicarbonate transporter and so in the blood. Then the bicarbonate can react with the increased hydrin islands and then decrease the blood pH once again. So this system is a very fine be control system. It's it's quite important concept. You have to know this effectively, have blood gases work and how pH in the blood is regulated. So we're gonna come back a little bit more, but moving forward looking at the ascending loop you guys might have had of this. Let me just been some way you guys might have heard of the A transporter called the NK CC Transporter on So effective. And what is this in the name encase. You see, it transports a sodium potassium I on on to Florida. The potassium in Florida Islands convention be transported. CO Chance wanted into the blood on the sodium. It works in same way they did before it. It gets transported in to blow by a sodium potassium pump. So that's basset important thing to know the NK CC transporter in the ascending loop of handy again I'm gonna remind you guys once again remember, there's in the descending loop This the descending loop of Henle E is where water is reabsorbed on increases that the concentration of ions in this ending loop And that's how this works. Living forward again. Stick with me over Busy over busy slide Um, looking at the distal, convoluted tubule The first, I guess, signs that we want you back in the blood sodium and chloride they get transported together, co transport her throat, go code transporter sodium once again enters the blood fire that sodium potassium pump ATP dependent on important thing to know is that the potassium can move I/O of the Lumen freely. The chloride ion has his own special transporter. It gets transported into the blood. The other other islands are transported Reabsorb story in, uh at the d. C t r. Magnesium and calcium. And formally people thought that they got back into blood through diffusion or they kind of moved freely. But it's now more agreed that there's a there are gap junctions or there's the captions, and this you can see allow the magnesium and chloride irons to move into the blood, looking at the CT and collecting ducts again. Other. There's there's a few. There's a transport. There's a few transports that worked in both. So again there's a sodium hydrogen ion, um, anti porter and transporter that put that transports sodium back into the blood and Hydra islands back into the Lumen. Once again, you can get this reversible equilibrium reaction. You can get water and oh to being produced. So two, then diffusing into the blood, increased CO2 consolation. The blood increases blood city on being a really hard. That is now and again in the cell. There could be this that the equilibrium then resets this on the bicarbonate need to enter the blood on. This is why I asked you to note the soda independent a re absorb here in the DCT and collecting ducts. The bicarbonate is actually transported into the blood to react with the hydrogen via this on DePorter. So we get chloride ion moving into the cell and then bicarbonate moving into the blood and in the blood can react with the hygiene. I on decreasing blood. Ph And then again, we don't talk about this fine system of, um, blood, blood, acidity. Another important concept. So bear with me again with this one. I'm sorry. Let me just move this out of the way. You get s Oh, yeah. So the important thing to note is that it's not so The independent the bicarbonate results in but is through chloride. It's chloride dependent. You can get sodium get transported into blood by the potassium transporter. But this time it's not ATP dependent. This transporter is regulated by aldosterone you guys might have had about the stream before. Um, and on aldosterone is basically a hormone that's secreted by the adrenal cortex. I'm not gonna go to into I'm gonna I'm gonna give you a bit, but he's a trailer. But my nice friend Pap is going to do a lot more on hormones like this tomorrow. And so I hope I see guys that November plug. But so that's autostrada. Almost right. Acts on the sodium transporter and increases the sodium and water ribs or re absorption in the blood. What I can happen from this, though, So why would you want that? We're going to look, we're gonna look at this little bit more with the system, but the ALDOSTERONE. Is released by the adrenal cortex in response to put it like in response to low BP on again, where where to be saved, BP could be detected. It's the kidney and the the Jack Stoglin Maryland apparatus. The macula denser cells. They can detect this low BP on effectively. Then release a lost your own from the renal cortex. Um, the this is fine. So obviously sodium then moves back. Moves into the blood water follows with that. But a problem with this is that the potassium then gets secreted back into the collecting ducts and DCT. And so this thing cause a thing called hyperkalemic hypokalemia being just low potassium. So we're looking at 11 more in a bit, but come in the final part. They're collecting other collecting ducts is this is where the last concentrating area for urine is? Um, we have these things called Aqua for into that increase the osmolality. So you get more salutes in the lumen of the nephron of urine when the body resorbs this water, so aquaphor is is you can see right there is regulated by a th it's 88 is released 88 being anti diuretic hormone is released by the posterior pituitary gland. On what the it does is increase is a backup or into active warrant us a specific transport there which, which increases water results in at the collecting data. So coming to the rast system, I love calling in the right system. But all the Russ what is the right system? The Roxicet is Renan angiotensin two aldosterone. So, um, the key things with this is why would read and be released? So many is released in response to a few things. Um, it's released to to reduce sodium in the DCT. Remember, the DCT comes around and it it it kind of meets the arterial uh, the arterial arterioles at the AL a junction of the Humira list. On there are these sell the macula denser cells that detect sodium. They are released in response to reduce perfusion pressure or BP detected by barrow receptors in the Afrin arterial on also biased, sympathetic stimulation off the apparatus. So what does run and do it converts and you're tense in urgent released by the liver we're seeing, is it of it? It's good. It's released by the liver on Brennan converts angiotensinogens into angiotensin one, and attention one is converted into angiotensin to buy a a six on a cyst produced by vascular endothelial cells. On this conversion, maybe a cousin, the lungs and attention to acts on the adrenal cortex. And so we'll talk about the adrenal glands a little bit. Here again, this is just the teams the tradeoff for tomorrow. But the adrenal glands are made up of adrenomedullary on the adrenal cortex and the drill for Texas. They're further split up into three zones. On the way to remember these three zones are G f R. So what What is the g f r. So it could be like TFR. But the way to remember is owns a g f r. The three zones are zona glomerulosa zona for sick. You lotta and zone out reticularis on they they produce different hormones. And again, you're gonna let they're gonna look at this a little bit more in depth later on. But these hormones, then the hormones that the G f produce are the way to remember is salt sugar sex hormones on again. I'm not a drill on this too much, but I just want to let you know that, you know, cortex, three zones. GFI is the way to remember it on the adrenal manjula extra hormones such as the epinephrine nor adrenaline. So come back to aldosterone. What does aldosterone do? Increases the sodium channels? Um, you might have heard of channels in your A level. When it comes to cystic fibrosis on what it does, it just increases the sodium resorption. So with soda results in follows, fluoride results in this is sold to retention. On with sold retention comes water retention. And so why is that important? And so that's what we'll look at here. So this is a diagram that everyone loves the diagram. So, as I said, Angiotensinogens comes from liver ran in from the kidneys from the lungs. So the system works. So this is somewhat as a negative feedback loop known as the to below glomerular feedback. Um, and so what? It does the angiotensin two works on different parts of the body to increase BP on decrease the blood volume effectively. So that's what I want you to stay from this. Is that just as we said, like with salt, retention comes water retention that think that with water retention comes increased blood volume and increased blood volume comes increase BP. So when BP is low again detected by the kidneys running, released and then it goes into the system, you can read up on this in your own time. As you said, there's different. There's different actions to Angela Angiotensin two. But other said when when the BP increases, this is then detected by the apparatus in the kidneys on this, then effectively tells the kidneys all we increase the BP. Enough now, stop release. Um, Brennan. And so that's what that negative feedback loop is. Another. Another way. The feedback loop works is through a M. P, and I'm not going. Try Teo. Pronounce that cause I can't have tried before. But envy is released by the stretch of atria when the BP increases. So when there's increased burn volume, the heart has to work harder. There's increased BP on this, then releases and pee that inhibits Renan. So that is this feedback loop that we're talking about again. You guys gonna get the slide so you can look through these specifically on Then? Everybody loves the table, just of the hormones and the actions, but we're gonna move forward. Um, I'm gonna power through. I I'm gonna when we are. Yeah, just get through it. There's no break of sorry, guys, but we'll get through it. So next section sell signaling. So if you have it with me in PCs one, we did the first part of sale signaling this's now the secondary messengers. We're looking at the importance and the use of second rest injures. So the first thing that's different mechanisms of intracellular second thing. So this is quite common. This is quite easy concept. I'm not gonna do well on too much, but the different mechanisms are crying. You get cell targeting the water crisis cell, talk to yourself just a crying cells that target cells nearby or next to it through gap junctions, power crying, being cells targeting local cells, and then endocrine being cells signaling too distant cells through through the bloodstream through hormones. And that's when you look at now, um, so that another thing I need to know is the different types of receptors, so you can get that like and gated. We're going to look at some of these little more specifically, but just generally you can get like a gated iron channels on. These are basically transmembrane protein complexes that conduct iron flow through the binding of new transmitters and see like in as the name suggests, examples of this is the gabapentin a serotonin receptors. They are different to the Baltic created channels which are more to gauge. Tunnels are sensitive to membrane potentials. We have the GI PCR, which we're gonna look at, but they use the messengers. We have enzyme linked receptors on, so what you get is a signal, a monocle attaching to the receptor, and then this causes a cascade of catalytic reactions. An example of this is the insulin receptor by a tyrosine kinase is and so enzymes. Receptors are receptors for many growth factors and cytokine is it hormones on. They play a major role in the regulation of cell growth, proliferation differentiation. Mutations in this, like the tires in kindness, receptor eyes, actually responsible for a lot of the disease is you might have heard of, So you get diseases such as cancers new or did degeneration and after a scoliosis through mutations. And I'm like receptors on the final one is just your nuclear receptors. We're gonna look at now, but they're activated by steroid hormones. The question I have for you is what is the need for secondary messengers? So what you get are two different types of hormones act differently. Eso you? You can get peptide hormones that are soluble in plasma on. They act by a surface receptors on. So these are fast acting but short lived because and we'll see. We'll see, because they just they only work through secondary Certainly message cascades. Where is thyroid hormones and all started hormones. They work by crossing cell membrane on acting on interstellar receptors to change transcription. So these are slow acting, but it takes a bit longer. Teo get activated, but they are. Look, then that the effects are longer lived. The steroid hormones are converted. They can be converted into more active or less active hormones, so you can see right there there's the receptor protein back and kind of amplify it or make it less active. Um, on they act by a transcription translation. So they literally angel it in synthesis on. So this is, um, or of a longer term, longer lived effects compared to peptide hormones. So peptide and start hormones are involved in homeostasis but steroid Homans arm or for developmental homeostasis. So going off with another question? This we're gonna look at this a little bit more again. It's just to see if you guys still engaging with me power. If you don't mind to say that the pole so so this'll It's just a test. Your knowledge is See where on is with this. No problem. If you get it wrong, I pee three and DHEA are important in stimulating release off calcium from the smooth endoplasm it reticulum for smooth muscle contraction. Which of the following converts Pip to be three and the major. So is the pole up? Sorry. Thank you again. Just want to see I'm gonna get a good good stab know. Probably if you get it wrong. We're gonna look at it now. Does that give you a few seconds in the song? Says we're gonna Yeah. Look at that now. Yeah. Okay. Come on, guys. Say full participation. Just want to see everyone get involved. That's why I'm all about participation. Metal. Very well done. So, you guys are a lot of you guys are getting the right answer. Um, two more seconds on. I think it ended there. Thank you. Um and so the answer is foster like pays. See? So it was a very well done. And we'll look at why that was, um So again, free warning. This slide is worthy, but bear with me. Um, so G protein couple receptors, cheesy GPC are quite important concept to get your head around. If you guys don't take anything away from this, I just want you guys to understand the almost just understand the, uh, just the concept of it. There's no there's only like, if you and if you don't understand it specifically the specific parts of it. You just need to know how these do You proteins work because they are seen in everything. And so when you start case and when you start learning a lot more pathologies, you're going to see these, um, thrown out a lot. So you just give me expected to know how they work. So there are freedom types. DSG I and D Q t s being similar. Trade e I be inhibitory antique. You They didn't quite know what the name is so much. Thank you. Um, so we're going to look, as I said, we're gonna look at how the steps involved in the receptor activation. So with G s were looking Yes. First ST. Military. You get this primary message of signal a molecule that binds to the protein and this causes a confirmation or change in the G protein. Um, then this corporation change causes GDP to be exchanged for GTP on this that activates the G protein thing, activates it. Deproteinization activated this protein, then stimulates Adelate cycle is which converts ATP in to see a m p eso. I'm gonna go to her again because I think I messed up a little bit. But again So I with the signal molecule primary messenger by instead gs But the GS 40 cause the confirmation will change this The GGTP is exchanged with the G g T P. On This causes the do protein to be activated. That's important, but this protein actuation stimulates as the a C to convert a TB into CMP. This the CMP that activates the protein kind of a so activated protein kind of achy. And then it's a different cell. It effects eso. The important thing to note is that phosphodiesterase digest CMP and so that kind of inhibits or stops the parkway. This is how the GS protein works, G I works by eight the a signal in molecule binding to the G protein and effectively inactivating yes, it inhibitory on. So then this cascade of this calf isn't activated. And so then that is There's an inhibition GQ It's a little bit different, but near the same similar to same There's a receptor activated triggers a confirmation of change G g d p is exchanged GTP on the G protein is activated Protein simulation The protein certain protein stimulates phospholipase seat. So this is what this what? The question was about before the foster likely see, then capitalizes Pip Pip s a p A p. I picked to be converted into IV three and d A. G. They then go on. So d a d e. Then goes on to activate protein kind of. See, As we said before, it was not pretty kind of a pretty fancy, which then goes on to exert different effects. And then I'd be three binds to end up last night. Particular, um, where that that you might have seen in a smooth muscle contraction. The IV three then causes release of counsel my own's for muscle contraction. So that is the basis of it. As I said, like if you don't take anything else from it, just don't know. I don't want you guys to understand the concept of it, so that signal molecule activates the do protein causes a bunch, a cascade off reactions, which then exerts further senator effects. But this is the this is these are the main points you know. Another pathway want us to look at is the nitric oxide pathway, so it works in a similar way so that there's no nitric oxide that diffuses into the muscle you get. You get converted, you get a rash in the GTP converts into see GMP. On this that activates protein kind is G. That's loads of protein kind of sense that you know, But just remember which one the which so protein kind of a for gs protein kind a Z See for GQ on for this nitric oxide pathway. Pretty kind. Is GI on? What does this protein kind of you do? It It's deactivates the smooth and apartment ridiculous. Um, to start releasing calcium on D acts on the myosin like chain phosphatase on phosphatase is is they? What they do is remove phosphates from things. So the mice in light chain phosphatase is removed phosphate from the mice and head. And then this stops cross blue tackling and causes of relaxation in the smooth muscle. You might ask your cells Where is this nitric oxide coming from? Were saying that it diffuses into a smooth muscle. Just a side note. The nitric oxide is actually linked with the protein, the GQ protein. So obviously GQ activated Pip Pee I Pee Pip to gets converted to D three and the EKG I pee three acts on the smooth in the past. It ridiculous to release calcium ions. Calcium them by instead of this thing called calmodulin. On this, that complex then acts on nitric oxide. Cindy's on $90 and something synthesizes Patrick oxide. So as you can see already, we're seeing a lot of links. So why does nitric oxide come from? It's linked with the GQ protein to make, um, that you excited? So the important thing to know is the example here is and I feel yourselves produced nitric oxide to call smooth muscle relaxation that leads to vasodilation. Um, so just another important concept you guys take away. But as I said, like you're going to see the reason we go through all these basics, political science is it's actually apply it later on when you look pathologies on, so you're gonna need to have a basic grasp of it on. That's why it's quite important. Know, even even if you don't know the name of the molecules And if you don't know, even even when it comes to, um I've got tell, you want to come to buy a chemistry Even if you don't have a specific molecule, sister, understand the stop in the end and the why why is it being like me and wise it being activated? That's what you need to take away from these pockets. But I said you got to look through these fights when you get it. Um, but moving on chromosomal abnormality, structure and abnormalities. So, first of all, we're gonna look at structure term karyotype is is this two again kind of two different uses for it. Karyotype is an individual's collection of chromosomes, but it's also used to refer to the like. The laboratory technique used to take that this image of the carrier time because I carry a typing takes an image of the karyotype. It's very confusing, but in our contacts were just looking at karyotype as an individual's collection of chromosomes. Um, S. So the use of this is that you can look for abnormal, abnormal numbers and structures of chromosomes. So how do you record a karyotype recorded as the number of chromosomes, the identity of the sex chromosome and then the active ality? So as you can see that a normal female is 46 xx of 46 being the number of chromosomes. Ex ex being sex chromosomes indicating female on There's no abnormalities mail similar similar thing but X y Turner syndrome. It's the missing off a sex chromosomes, so you as a number of chromosomes, you have 45 then the identity of sex from's office X on the abnormality is that there is a missing a chromosome, a male with down syndrome, so we're gonna look at this a little bit more. It's down syndrome is the addition of a extra chromosome 21. And, as you can see about the number of chromosomes would be 47 x y being male and plus 21 being the abnormality. This slide is looks a little bit confusing, but I'm gonna tell you what you need to take away from it. So in medicine, obviously, you're not going to be asked to be able to classify specific bands within a chromosome. But you just need to understand this concept quite basically in border. Thing to take away is that you can recognize a chromosome to two terms of together, but bound by a centromere are two sister permitted with sister permitted. As you get closer with chromosomes, you get this short time in a long arm on. That's the most important part to take away from here. The short arm is P is referred to as P. On. The way to remember is that he goes for petite, so petite make small, short term on cue is, the longer so that's the important thing to take away. He is a short term petite and Q longer And you might be you might be presented ever with this kind of notation on. So you just need to be able to look at it, kind of understand what they're trying to tell you. So you might read research papers. You might read things on genetics on. They might present it to you this way. But you just need to be able to recognize that when you look at this notation, the X is the chromosome. The P is the arms that could be your cue on. Then you get these bands. So obviously you, as a medical center on not expected, no different bands. But just recognize that there are these different bands and that's how you classify them. That is chromosome mutation. But again, as I said, take away that P Q. P being short on cue longer. So with this comes a few important definitions. I'm going to let you guys look read into polyploid E. It's just a polyp or areas. Um, it's just a presence of extra set of homologous chromosomes, but what I want to focus on his annual party, an employee is an abnormal number of chromosomes and So with that, you can get monosomy or tries any more than being one so easy to remember. Monavie and one, you get absence of a chromosome and tries only being try. Three. You get the presence of an extra chromosome. Um, an example of this is monosomy X. Also notice tightness in dramas we saw before the missing of the sex chromosomes. Um, Andi tries. Oh, me an example of this is Trans Only 13. Also, potatoes syndrome. On another one, you might know it's trying to only 21 as we just saw dancing room. So this is important concept. I want us to take away a swell where the down syndrome, the genetic causes. So, um, with Down syndrome, 95% of the cases cardiogenic causes are non destruction at my OSIs. And so what? What, what? Because in in this, basically, you get non dysfunction, either Medicines, two medicines, one where so you may have none destruction of answers to you have to homologous pairs of superlatives. They split into to equal daughter cells. You get to chromatin. It's two sister permitted, but they one will not split evenly. And there's no there's no there's none disjunction, um, effectively so you can see they're at Mayo Cysts to there's non Destruction, which causes a gammy toe. Have two pairs of the sister Chromatid. It's on. When this gets fertilized, you effectively get three chromosomes, so that is non dysfunctional masses, too. None destruction masses. One is when the two hum ologists has. They don't split. You get you get, then further may assess where you get to sister committed in each daughter cells they could get first lies on and they can. They gain another chromosome, and so you get chromosome. You get extra chromosome 21 another. Another genetic cause Off Down syndrome is Robert Sony in Translocation. This is 3 to 4% of the causes on, but this is effectively where each cell has an extra part of Comes on 21 or just entirely extra chromosome 21. But it's basically attached to another chromosome. Instead of being myself, you just need to know that there's this book. It's only on translocation a Z. You can see Dad. There's the imbalance where you get a part of comes on 21 or even a whole 21 causing that extra causing the extra chromosome 21 the final you might hear a genetic cause called mosaic down syndrome. It's a very rare type, and it's that it's the final type when it comes to down syndrome. On this is where the certain number of cells have an extra grams of 21. So not all have it, but sand do on that causes down syndrome effectively. So finally, we're gonna end off with a question. So can I ask? This is just to know if everybody stopping the right to the end of it. If you guys have retained this little, keep their knowledge. The question girls. Which missing area? Which of the following carrier types would correctly described a female with down syndrome? Trisomy 21. I'm hoping, should be quite straightforward. I'm hoping. Come on, guys, let's get full participation here again. A female with down syndrome on down to room is tries only to anyone. Try being an extra chromosome extra comes every 21. And remember how we described Harry types? So a few more people Well done, guys. Must you guys getting it? Very well done. Okay, I'm gonna end it there. Thank you. Thank you. have, and so the answer is very well done. He is 47 xx 21. So I'll plus 21. So I'll explain that 47 being the number of chromosomes. Remember trisomy extra set of Grandma's own extra set of extra 20 chromosome 21 That's the abdomen is described on the remember females have to x chromosomes. The males have an X y set of chromosomes. And so that was the other thing you should take away from this. So these are references. And I guess I want to say thank you, everybody for security to the end, a siendo of my recession. Um, I hope the feedback for me has been given out. Please, if you have any questions to drop it in the chat on, don't forget to fill the feedback form if you want. Um, you want the sides on? Also, I want to say with the SBA session in January, it will be high your content. That's gonna be a lot of STDs. It should be before your January exam. So please do join in flats be a session as well on the link for that has been added on then, um, I guess the other thing I want to say is our our year one. We're looking for a year. One publicity's leads. So please, for that form out as well if we have really great opportunity to join our skis. He joined the team on Help us out. Thank you guys. Anything else to be said? Other than that, Thank you very much. Everybody for joining. Thank you for staying. So the ends and, um, answer those questions at all. I hope that was helpful. Yes, it will look amazingly portfolio to be a help. To have joined an organization in first year itself would be really good. So we are looking for your one publicity's means. Please do, um, please to apply. Thank you guys again. If you guys have any questions, let me know. Um thank you. Tree and Poppy. Yes. So that do we get the recording as well? Or thank you for reminding me