Download Goljan USMLE Step 1 Audio Lectures Free
Content sample from Audio Lectures:
“1. Most imp: have to go into anaerobic glycolysis; end product is lactic acid (pyruvate is converted to lactate b/c of increased NADH); need to make NAD, so that the NAD can feedback into the glycolytic cycle to make 2 more ATP. Why do we have to use anaerobic glycolysis with tissue hypoxia? Mitochondria are the one that makes ATP; however, with anaerobic glycolysis, you make 2 ATP without going into the mitochondria. Every cell (including RBC’s) in the body is capable of
performing anaerobic glycolysis, therefore surviving on 2 ATP per glucose if you have tissue hypoxia. Mitochondrial system is totally shut down (no O2 at the end of the electron transport system – can only get 2 ATP with anaerobic glycolysis). Good news – get 2 ATP Bad news – build up of lactic acid in the cell and outside the cell (increased anion-gap metabolic acidosis with tissue hypoxia) due to lactic acidosis from anaerobic glycolysis. However, causes havoc inside the cell b/c increase of acid within a cell will denature proteins (with structural proteins messed up, the configuration will be altered); enzymes will be denatured, too. As a result, cells cannot autodigest anymore b/c enzymes are destroyed b/c buildup of acid. Tissue hypoxia will therefore lead to COAGULATION necrosis (aka infarction). Therefore, buildup of lactic acid within the cell will lead to Coagulation necrosis.
2. 2nd problem of lacking ATP: all ATP pumps are screwed up b/c they run on ATP. ATP is the power, used by muscles, the pump, anything that needs energy needs ATP. Na/K pump – blocked by digitalis to allow Na to go into cardiac muscle, so Ca channels open to increase force of contraction (therefore, sometimes you want the pump blocked), and sometimes you want to enhance it.
With no ATP, Na into the cell and it brings H20, which leads to cellular swelling (which is reversible). Therefore, with tissue hypoxia there will be swelling of the cell due to decreased ATP (therefore will get O2 back, and will pump it out – therefore it is REVERSABLE).
In true RBC, anaerobic glycolysis is the main energy source b/c they do not have mitochondria; not normal in other tissues (want to utilize FA’s, TCA, etc)”
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