Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

1507 > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

1-urinary system

2-kidneys-location

A

1-has 2 kidneys, 2 ureters, urinary bladder, & urethra

  • urine formation occurs w/in kidneys and the rest transport/store urine
  • urinary system is posterior to the parietal layer of peritoneal membrane—retroperitoneal

2-w/in ab cavity, lateral to 11th thoracic & 3rd lumbar

  • r. kidney is inferior to l. kidney
  • anterior to kidneys= spleen, stomach, liver & gallbladder
  • posterior to kidney= innermost thoracic, inferior of diaphragm, muscles of posterior ab wall, &&& ribs
  • each kidney= in protective fat & fascia: superficial to deep—
  • parietal peritoneum (anteriorly) & fascias of posterior ab wall (posteriorly)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

1-pararenal (retroperitoneal) fat

2-renal fascia

3-perirenal fat

4-renal capsule

5-surgical access to kidneys

6-external anatomy

A

1-thick fat pat, helps hold kidney in place against posterior ab wall

2-anterior layer, covers renal vessels medially,
posterior layer merges w/ transversalis fascia laterally & w/ fascia covering diaphragm, enclosing adrenal glands

3-surrounds kidneys & adrenal glands

4-tough fibrous covering

5-posterolateral approach—incise inferior to level of the 12th rib to avoid the inferior extent of the diaphragm

6-kidney bean shaped—size of a large bar of soap

  • convex on lateral surfaces & concave on medial
  • hilum= on medial surface & is longitudinal slit opening allows vessels, nerves & ureters in/out of kidney
  • adrenal glands sit atop the upper pole of the kidney
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

internal anatome of kidney

1-renal cortex

2-renal medulla

a-renal pyramids

b-renal columns

c-major/minor calcyes

d-renal pelvis

e-renal sinus

A

1-outer layer of kidney, consists of nephrons that filter blood to produce urine

2-deeper layer of coneshaped renal pyramids, separated from renal columns

a-7-18 in each kidney, has collecting tubules that concentrate & drain urine away from cortex towards the ureters
-apex or papilla of each pyramid projects into minor calyz where multiple ducts empty their products

b-extensions of cortex between medullary pyramids, has segmental BV & lymphatics

c-tributaries of renal pelvis that collect urine draining from papillae of medullary pyramids

  • papillae evaginate into & surround minor calice
  • minor calcie merge to form major calyces that merge to form renal pelvis (upper part of ureter)

d-exits kidney through hilum & becomes ureter

e-fat filled space that has pituitary vesses and nerves of kidney plus the renal pelvis
surrounded by parenchyma of kidney & opening of the renal sinus is the hilum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

1-Ureters Location

2-ureters gross anatomy

A

1-arises from the renal pelvis & goes inferiorly from kidney to the bladder through the posterior ab & pelvic cavities
-pass posterior to the gonadal (ovarian & testicular) vessels which also go inferior toward the pelvis—ureters cross iliac arteries at the pelvic prim to enter the pelvis

2-slender, muscular tubes that convey urine from kidneys to the bladder via peristalsis
-ureters enter the bladder wall postero-laterally and run w/in bladder wall before opening into the cavity so they are pressed shut when the bladder fills w/ urine preventing reflux

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Urinary Bladder

1-location

2-gross anatomy

3-external anatomy

4-internal anatomy

A

1-in pelvic cavity & is subperitoneal—posterior to pubic symphysis

  • in males= superior to prostate & anterior to rectum
  • in females=anterior & inferior to uterus & anterior to vagina

2-bladder is muscular (SM) sac capable of collapsing & expanding depending on vol of urine w/in—DETRUSOR muscle squeezes urine out
-as bladder fills, superior surface ascends above pelvic brim into falso pelvis & up to umbilicus (belly button)

3-bladder has 4 sides—base (vaginal wall or rectum in males)
superior surfaces (covered w/ periotoneum)
2 interolateral surfaces
-has 4 anges—apex(median umbilical ligament)
neck-inferior part pelvic for females & prostate for males
2 lateral agnles—ureters enter the bladder

4-trigone= inferior, smooth walled triangular region demarcated by 2 ureteris opening & internal urethral orifice
bladder neck=urethra exits urinary bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

1-kidney reflux

urethra

2-location

3-gross anatomy

men

4-prostatic urethra

5-membranous urethra

6-penile urethra

A

1-vesicoureteric reflex—failure of ureterovesical valves—normally prevent urine from backflowing into ureters—-back flow inc the pressure in ureters & may cause tissue damage & kindey infections
in kids= kidney failure

2-urethra goes from inferior bladder to the external body wall to open at external urethral orifice in penis or vestibule (females)

3-thin walled tube w/ mucosal lining that drains urine from bladder

  • detrusor muscle of bladder thickens= internal urethral sphincter—innervated by ANS
  • external urethral sphincter= skeletal muscles, encircles the internal sphincter & urethra—innervated by somatic S2-S4
  • women= short urethra & external origics is close to anus & vaginal opening
  • men= urethra= 20 cm and is subdivided

4-portion goes through prostate

5-portion goes through muscular & fascial layers= urogenital diaphragm

6-portion w/in corpous spongiosum of penis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

1-kidney stones

2-cystitis

A

1-form from crystallized Ca, Mg, or uric acid salts w/in calices of kidneys, in the ureters or urinary bladder

  • stones likely to lodge at beginning of ureter, where ureter cross external iliac, and at inferior of ureter going into bladder
  • stone may go from kidney into renal pelvil and then into ureter= distention of tube ===ureteric stone—causing pains refferred from T11-L2
  • stones passed normally or removed surifcally—ultrasonic wave tech to break up stones

2-inflammation of bladder due to variety of syndromes—bacterial infections. women are prone to UTI bc of shortness of female urethra & closeness of vag & anus (e coli)—if untreated= from bladder and to ureters to infect kidneys (pyelonephritis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Vasculature

1-kidneys

2-ureters

3-urinary bladder

4-renal transplantation

A

1-arterial blood supplied by paired renal arteries from ab aorta—renal arteries enter at hilum of kidney & breaks into segmental branches

  • venous drainage is via segmental veins to paired renal veins that will go to IVC—renal veins= anterior to renal arteries
  • –l. renal vein= l. testicular/ovarian vein & l. suprarenal vein
  • —r. testicular/ovarian & r. suprarenal drain into IVC not r. renal

2-Ab portion= arterial blood via ab arteries: renal, gonadal, & ab aorta branches…veins= renal & gonadal veins
pelvic portion= arterial blood via common & internal iliac arteries…veins= pelvic ureters follow corresponding arteries w/ same name

3-arterial portion= from branches of paired internal iliac that branch from common iliac arteries in pelvis

  • –superior vesicle artery to superior portion
  • –inferior vesicle artery (males) & vaginal arteries (females) to inferior portion
  • venous drainage of bladder is via venous plexus on inferolateral surface which draines into internal iliac veins and that drains into common iliac veins then IVC

4-kidney transplants are a treatment option for cases of chronic renal failure

  • transplanted kidney is placed in iliac fossa of greater pelvis—placememnt physically supports kidney so traction isnt on newly grafted BV
  • renal artery & vein are joined to external iliac artery & vein and ureter is sutured into urinary bladder—-non functioning kidney is left in place
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Kidneys Innervation

A
  • symp innervation to kidneys= vasoconstriction of renal vessels
  • –thoracic & lumbar splanchic from T10-L1 spinal cord carry pregang symp nerve to prevertebral aorticorenal ganglia where they synapse
  • –postgang symp fibers enter renal plexus—plexus of postgang symp, pregang parasymp & visceral sensory along renal arteries & follow branches to kidneys
  • parasymp innervation= unclear—pregang parasymp to kidneys are carried w/ vagus nerve & synapse in walls of target organs
  • visceral sensory fibers detect distention w/in renal capsul, renal collecting system, & ureters
  • –fibers go retrogradely to CNS w/ symp fibers—cell bodies of visceral sensory fibers are in DRG of lowest thoracic & upper lumbar spinal nerves
  • –visceral sensory fibers w/ symp fibers= visceral pain w/ symp distribution of kidney & ureters
  • –pain & reflex muscle spasm= produced over groun, scrotum, anterior thigh
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

1-ureters innervation

2-urinary bladder innervation

A

1-unclear for ANS—parasymp innervation inc peristalsis & symp inenrvation inhibits peristalsis
-visceral sensory fibers for pain travel w/ symp motor fibers back to CNS…ureteric pain= severe & spasmodic bc of peristaltic action= groin, flank, thigh

2-somatic motor= external urethral sphincter= voluntary motor control via pudendal nerve S2-S4

-symp= inhibits constriction (relaxes) detrusor muscle & constricts internal urethral sphincter= bladder filling—-Thoracic & lumber splanchnic T10-L2 carry pregang symp nerve fibers to inferior mesenteric gang & gang of inferior hypgastric plexus &&&& postgang pass to bladder

  • parasymp= stumulate constriction of detrusor & inhibits constriction (relaxes) of internal urethral sphincter—urine flow out of external urethral sphincter —pelvic splanchnic from S2-S4 carry pregang parasymp to inferior hypgastric plexus
  • –parasymp fibers go through plexus to bladder wall where synapse

-visceral sensory= detect distention & pain in bladder
pass retrograde to CNS w/ both symp & parasymp motor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

1-development of urinary system

2-kidneys

a-pronephros

b-mesonephros

c-metanephros

A

1-from intermediate mesoderm in posterior body wall of embryo

2-final set of kidneys & ureters from series of embryonic kidneys & duct system—embryonic kidneys from condensations of intermediate mesoderm= urogenital ridges—along posterior wall of ab cavity—lateral portions of UG ridge form longitudinal duct systems on either side of embryo & medial portions have sex cells that give rise to gonads

a-wk 4—first paired kidneys—pronephroi develop in cervical region= pronephric ducts. ducts connect primitive kidneys to cloaca—pronephros= non functioning but gives template for 2nd kidney to develop
—cloaca= primitive—tail end cavity into developing intestinal, genital & urinary tracks open

b-wk 4-5, 2nd kidneys, mesonephroi form & claim pronephric ducts becoming mesonephric wolffiant ducts…mesonephric ducts connect mesonephroi to cloaca

  • –males= w/ testosterone= mesonephric ducts give rise to ductus deferens—ducts degenerate in females due to absence of testosterone
  • –second duct system forms lateral to mesonephric ducts= paramesonephric ducts= uterine tubes ,uterus & upper vagina in females—degenerate in males

c-wk 6—paired ureteric buds from mesonpheric ducts near cloaca

  • ureteric buds form renal pelves, calyces & collecting tubules of final kidneys, metanephros
  • distal part of mesonephric duct becomes the utereter—metanephros migrate superiorly into upper ab
  • —wk 6= cloaca divides into 2 chambers: urogenital sinus= rise to future bladder, urethra & lower vag
  • –rectum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

1-components of urinary system

2-kidney function

A

1-2 kidneys, 2 ureters, urinary bladder, urethra

2-exretion of urine (1-2 L)—metabolic wastes (urea, uric acid, creatinine) & foreign substances or breakdown products

  • regulation of total body H20
  • regulation of electrolytes (Na, Cl)
  • control of acid-base balance—bicarb
  • endocrine secretion—erythropoietin= stimulates blood cell formtaion
  • –renin= influences BP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

1-Kidney

2-hilus

3-sinus

4-renal pelvis

A

1-bean shaped, convex lateral, concave medial, posterior ab wal, retroperitoneal & dense CT capsule

2- indentation of medial border—renal artery, vein lymph, & nerves enter + leave
-renal pelvis leaves

3-cavity that extends inward from hilus

  • surrounded by renal parenchyma
  • contains renal pelvis
  • remainder of sinus filled by loose CT & fat

4-funnel shaped expansion of proximal ureter

  • –major calyces= 2-3 per kidney
  • –minor calyces= 8-12 per kidney
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

parenchyma of kidney

1-cortex

2-medulla

A

1-outer dark layer

  • –medullary ray= radially directed striations (formed by tubules) into overlying cortex
  • –lobule= consists of medullary ray & surrounding cortical tissue

2-inner lighter layer
-renal or medullary pyramid—base towards cortext
apex/papila into minor calyx
—area cribrosa = tip of papilla perforated by 10-25 openings of collecting tubules
-renal columns—extensions of cortical tissue between medullary pyramids (part of medulla)
—lobe consists of pyramid, overlying cortex & surrounding cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

1-inerlobar a

2-arcuate artery

3-interlobular

4-afferent arteriole

5-glomerulus

6-efferent arteriole

7-2nd capilalry bed

8-other arteries/veins

A

1-remal columns between pyramids

2-arched over base of pyramids

3-parallel w/ medullar rays

4-supplies blood to glomerular capillaries

5-glbular tuft of fenestrated capillaries

6-drains glomerulra capillaries to 2nd capillary bed= portal arteriole

7-peritubular capilalry netword from cortical glomeruli—vasa recta from juxtamedullary glomeruli
—thin walled, dexcending towards papilla arterial limb, ascending towards renal venous limb, form hairpin loops, & is called vascular bundle./rete mirabile

8-arcuate veins, interlobar veins, renal arteries/veins
vasa recta, interlobular veins, peritubular capillaries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

uniferous tubule
A-nephron (formation of urine)

1-renal—malphigan corpuscle

2-proximal tubule

3-thin limb of loop of henle

4-distal tubule

5-loop of henle

6-cortical nephron

7-juxtamedullar nephron

8-colelcting tubule & ducts

A

1-glomeulus (capillray tuft) & capsule of bowman

2-convoluted & straight (descending thick limb)

3-descending & ascending

4-straight (ascending thick limb), macular portion & convoluted portion

5-thick descending limb (straight pt), thin descending lim, thin ascending lim, thick ascending limb (straight dt)

6-located near capsule, short loops of henle, extend only into outer medulla

7- located near medulla, long loops of henle, extend well into inner medulla & active in H20 reabsorption & urine conc

8-excretion of urine

  • –arched portion= short in cortex
  • –straight or descending portion= cortex to papilla
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Nephron

1-renal corpuscle

A

=glomerulus & bowmans capsule

glomerulus= globular tuft of type 2—fenestrated capllaries w/ thick basal lamina—afferent & efferent arterioles

Bowmans Capsule= visceral layer= modified epithelial cells= podocytes
—stellate shape, applied to glomerular capillary endothelium, radiatiing processes===primary(large/few) &
secondary(small, numerous, food processes)—interdigitated w/ neigboring pedicels, forms slit pores (covered by slit membranes), w/ prominent basal lamina
parietal layer= simple squamous, inc in height to become continuous w/ proximal convulted tubule

urinary bowmans space= between visceral & parietal capsule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Nephron
renal corpuscle

1-mesangial cells

2-vascular pole

3-urinary pole

filtration barrier
4-fenestrated endothelium

5-combine basal laminae

6-slit pores

A

1-phagocytic cells between capillaries, keep basal lamina clear

2-point where afferent & efferent arteriole enter & leave glomerulus

3-point where parietal layer of capsule is continuous w/ proximal convoluted tubule

4-no diaphragms of glomerular capillaries—retains only cell elements of blood

5- capillary endothelium & podocytes (continuous layer of filtration)—retains only large molecules of blood

6-w/ slit membranes—between podocytes—retains only small molecules of blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

1-proximal tubule

2-thin limb

A

1-proximal convoluted tubule

  • simple cuboidal
  • brush border= conspicuous microvillus covering on luminal surface of PCT
  • basal infolding of plasma membrane= striated, inc SA, many mitochondria, site of active Na transport

2-located in medulla
-epithelium= simple squamous, no brush border, looks like capillary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

distal tubule

1-straight ascending

2-macular portion

3-convuluted portion

A

1-abrupt inc in thickness of epi from that of the thin potion of the proximal tubule

  • inner medulla contains only thin segmens= collecting ducts & BV
  • epi= simple cuboidal, no brush border, prom basal infolding, site of active Cl transport, low H20 perm

2-specialized cells of distal tubule comes into contact w/ afferent & efferent arteriole of parent renal corpuscle
-epi= tall cuboidal to columnar, thinner cells, nuclei= crowded

3-short loops, above parent renal corpuscle

  • no diff in epi from straight portion
  • site of active Na transport
  • low H20 perm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

1-collecting tubule & larger collecting ducts

2-juxtaglomerular appartus

A

1-epithelium—diff from nephron

  • simple cuboidal (small ducts) to simple columnar (large ducts)
  • distinctly outlined cells
  • darkly staining round nucleusi
  • permeability under influence of ADH —released by neurohypophysics, presence of ADH causes permeability of collecting ducts to inc leading to an inc in reabsorption of H20 from tubules & more conc urine

2-modified SM of afferent arteriole

  • has granules that contain renin
  • –renin catalyzes conversion of angiotensinogen to angiotensin 1 then angiotensin 2 (systemic vasoconstrictor= inc BP)
  • –angiotensin 2 stimulates aldosterone release by adrenal cortex= reabsorption of Na and H20 = inc in total body water and BP
  • macula densa of distal tubule
  • cells of macula densa sense NaCl conc in distal tubule
  • macula densa cells mediate release of renin by JG cells effecting changes in electrolytes, total body water, and BP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Extrarenal collecting system

A

1-renal pelvis, ureters, urinary bladder & urethra

mucosa= epi= transitional epi for most part, inc thickness from ureter to urethra, impermeable to H20 & salts + lamina propria= dense

muscularies= inner longitudianl layer, middle circular layer, & additional outer longitudinal layer from distal ureters to bladder

adventitia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Pelvic Cavity Boundaries

1-pelvis major

2-pelvis minor

pelvic fascias

3-parietal pelvic fascia

4-visceral pelvic fascia

5-pelvic peritoneum

A

1-false pelvis—-continuous superiorly w/ ab cavity
Boundaries= lateral= iliacus muscle w/in iliac fossa/iliac crests
anterior= anterior ab wall
posterior= L5-S1 vertebrae
inferior= pelvic brim

2-true pelvis—from pelvic brim to pelvic diaphragm
boundaries= lateral= obturator internus & fascias
anterior= pubic symphysis
posterior= sacrum & coccyx
inferior= muscular pelvic diaphragm & fascias

3-investing fascias of pelvic muscles line pelvic cavity & are continuous w/ ab muscular fascia

4-between parietal pelvic fasic & pelvic peritoneum
has loose CT where neves & BV are transmitted & fibrous condensations that suppor pelvic viscera = ligaments

5-peritoneum invests ab organs extends into true pelvis & partially invests pelvic organs forming folds & spaces between them

  • –males & females= spaces on either side of rectum & urinary bladder (parerectal fossa & paravesical fossa)
  • –males= pouch between rectum & seminal vesicles/urinary bladder & fold between sacrum & prostate bladder
  • –females= pounches between rectum & uterus/vagina & between uterus & urinary bladder & fold between sacrum & cervic of uterus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Pelvic Viscera—males & females

1-ureters

2-urinary bladder

A

1-descend along posterior ab wall & cross over pelvic brim to enter the true pelvis
—water under bridge: females= ureter descends near ovarian artery & underneath the uterine artery to enter the true pelvis
males= urteres goes below ductus deferens
-uterers enter urinary bladder posterolaterally

2-rests against pelvic diaphragm & is separated from parietal & pelvic fascia & bony pubic by fat filled retropubic space
male= base of bladder in contact w/ rectum and separated by rectovesical pouch
neck of bladder= supported by prostate gland
neck= anchored to pubic bones by puboprostatic ligaments

female= base of bladder is in contact w/ uterus & upper vag is separated by periotoneum lined vesicouterine pouch

  • neck of bladder supported by muscles of urogenital diaphragm
  • neck = anchored to pubic bodies by pubovesical ligaments
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

1-scrotum

2-testis

3-epididymis

4-spermatic cord

a-external spermatic fascia

b-cremasteric muscle and fascia

c-internal spermatic fascia

A

1-outpouching of anterior ab wall that communicate w/ ab cavity via inguinal canal —posterior to penis & contains testis, epididymis & spermatic cord

2-male gonad—source of male sex hormone & site of spermatogensis (exocrine)

3-highly convoluted duct that lies between the testis & has ductus deferens, stores sperm & has head, body & tail

4-covered by 3 layers of fascia from layers of anterior ab wall

a-from fascia of external ab oblique m

b-from internal ab oblique m and its deep fascia
cremasteric m is innervated by genital branch of genitofemoral n & contracts when internal thigh is stroked, raising the testis…check integrity of L1 & L2

c-from the transversalis fascia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Contents of spermatic cord

1-ductus deferens

2-testicular artery

3-pampiniform plexus

4-autonomic nerves

5-vasectomy

A

1-musuclar tube, conveys sperm from testis to urethra

  • traverses to inguinal canal & goes superior to ureter as it courses towards the base of the bladder
  • base of bladder, ductus deferens lies medial to seminal vesicle
  • ductus widens into ampulla before joining seminal vesicle to form ejac duct
  • deferential artery & vein —blood supply

2-from ab aorta (inferior to renal a)

3-interwoven veins that surround testicular artery, combines to form testicular veins…r.testicular vein empties into IVC & l. testicular vein into l. renal vein

4-autonomic & genital branch of genitofemoral nerve

—also has lymphatics

5-surgical ligation of ductus deferens= perm method of birth control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Prostate gland and associated structures

1-seminal vesicles

2-ejac duct

A

1-densly coiled, blind tubes

  • posterior to base of bladder & lateral to corresponding ductus deferens, r & l. seminal vesicles meet at an angle, forming V shaped posterior to bladder
  • contribute to fructose & alkaline secretions to seminal fluid, doesnt store sperm
  • short duct of seminal vesicle joins ampulla of ductus deferens to form ejac duct

2-short ducts by union of ampulla of ductus deferens & seminal vesicles
-goes through prostate gland and opens into porstatic urethra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

1-prostate gland

2-blood supply innervation

3-clinical

A

1-largest accessory gland of male reproductive

  • cone shaped, walnut sized gland that has broad base & in contact w/ bladder & narrow apex resting on urogenital diaphragm
  • prostatic urethra & ejac ducts go through substance of gland
  • prostate contributes a white, alkaline secretion making up abotu 20% of seminal fluids, small ducts open into prostatic urethra

2-supplied by internal iliac a—venous blood drains to prostatic & then to the internal vertebral venous plexus
-autonomic innervation is via prostatic plexus=inferior hypogastric plexus containing both symp & parasymp nerve fibers

3-posterior of prostate & seminal vesicles are palpable through rectovesical pouch during rectal exam

  • benign prostatic hyperplasia = common in over 80
  • prostate cancer= hard irregular mass during exam—prostatic veins w/ internal vertebral venous plexus accound for high incidence of spinal metastases of prostate cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

1-penis

2-2 corpora cavernosa

3-corpus spongiosum

A

1-male organ of copulation—body (shaft) of penis is formed by 3 cylindrical erectile bodies bound by dense CT

2-r. & l. located posterior and fused at midline

3-unpaired midling structure ingerior to corpora cavernosa—terminates distally as glans (head) of penis
-traversed by penile (spongy) urethra—opens onto glans at external urethral meatus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

1-vagina

2-chadwicks sign

3-uterus

A

1-female organ of copulation & inferior end of birth canal

  • vagina lies inferior to uterus & posterior to bladder—goes anteroinferiorly and opens on the vaginal vestibule
  • anterior wall of vagina surround urethra for most of course, opens on vestibule of vagina between labia minora
  • at birth inferior vagina is closed by partial membrane, hymen—usually rupture at 1st intercourse
  • blood supply= vaginal arteries= branch from uterine artery
  • vaginal venous= plexus commincates w/ vesical, uterine & rectal plexuses

2-preg = inc vascularied & causes vagina walls to turn violet blue= early sign of pregnancy

3-non preg uterus= hollow, pear shaped muscular organ that lies superior to urinary bladder—normally antevereted & anteflexed (uterine body flexed relative to cervice & angled at 90 degree relative to vaginal canal)
-during preg uterus enlarges to accomodate growing fetus & placenta and wall thickens in prep for birth

31
Q

Uterus has 3 layers
1-permetrium
2-myometrium
3-endometrium

separted by isthmus into

4- body

5-cervix

6-clinical

A

1-outer layer from peritoneum & CT

2-intermediate muscular layer

3-innermost muscular layer= partially shed during menstruation, unless fertilized ovum has implanted itself

4-superior 2/3

  • *fundus**= dome shaped portion of uterus superior to uterine tubes
  • *cornua**= horns-superolateral structures at juction w/ uterine tubes
  • *uterine cavity**

5-cylindrical, inferior 1/3 of uterus

  • short narrow passageway
  • *internal os**- superior opening of cervical canal located at level of isthmus & continuous w/ uterine cavity
  • *external os**-inferior opening of cervical canal into vagina
  • *vaginal fornices**- anterior & posterior spaces between cervix & vaginal walls

6-cervix= firm and rubbery…hormonal changes early in preg = softening of cervix (goodells sign) & softening of uterine isthmus (hegars sign)

32
Q

1-uterine support

2-uterine blood supply

A

1–muscles of pelvic & urogenital diaphragm

  • condsensations of endopelvic fascia reinforced by SM
  • broad ligament of uterus= double layered sheet of peritoneum that encloses uterus, uterine tubes, and ovaries
  • round ligament= homologous to spermatic cord in males, remnant of fetal gubernaculum that traverses the inguinal canal & terminates in labium majus

2-uterine artery:

  • internal iliac a branch
  • ascending branch= uterus & uterine tube
  • descending branch= cervix, vagina, & urethra
  • At uterine isthmus the uterine a lies immediately superior & anterior to ureter (water under bridge)

uterine vein: uterine venous plexus surrounds cervix & isthmus that combines to make uterin veins that drain to internal iliac vein

33
Q

1-uterine (Fallopian) Tubes

2-intramural

3-isthmus

4-ampulla

5-infundibulum

6-mesosalpinx

7-vessels

8-clinical

A

1-hollow muscular tubes that go laterally from uterine cornua and continuous w/ cavity…open to the peritoneal cavity and get ovum from ovary
-site of fertilazation

2-region w/in wall of uterus

3-narrow region adjacent to uterus

4-widest portion of tube and most frequent site of fertilization

5-funnel shaped distal portion of tube that communicates w/ peritoneal cavity

  • –ab ostium= opening to peritoneal cavity
  • –fimbriae= 20-30 fingerlike projections that grasp ovary and guide ovum into infundibulum, single, enlarged obarian fimbria= attached to ovary

6-free superior margins of broad ligament of uterus that encloses uterine tubes

7-uterine tubes receive blood by anastomosing branches of uterine & ovarian arteries—venous blood follows same course

8-female reproductive tract =i ndirect conduit between pelvic peritoneal cavity & external environment= accounts for relatively high incidence of pelvic inflam disease in women
—patency of uterine tube= necessary for fertilazation, tubal ligation= form of birth control

34
Q

1-ovary

2-mesovarium

3-proper ovarian ligament

4-suspensory ligament of ovary

5-blood supply

6-innervation

A

1-female gonad—paired almond shaped organs, female sex hormones and site of oogenesis

2-subdivision of broad ligament of uterus that suspends the ovaries

3-derived from female gubernaculum & anchors ovary to uterine body

4-peritoneal fold raised by ovarian vessels as they course w/in folds of the uterine broad ligament

5-ovarian artery= from ab aorta inferior to renal a
ovarian vein= asymmetric venous return, analogous to that of testicular veins

6-ovary supplied by autonomic & visceral afferents by ovarian plexus (extension of aorticorenal plexus)

  • uterus & upper vagina= innervated by uterovaginal plexus, subdivision of inferior hypogastric plexus
  • uterine tubes= supplied by both ovarian & uterine plexus
  • lower half of vag= somatic innervation from pudendal n
35
Q

1-kidney

2-function of eryhtropoietin (EPO) from peritubular capillary cells

3-regulation of production of 1,25 dihydroxy Vit D3 (calcitriol) in tubule cells via activity of 1a hydroxylase

A

1-function of kidneys is to regulate the volume and composition of extracellular fluid
-also an endocrine organ via production of erythropoietin & Vit D.

2-EPO regulates process of differntiation of uncommited stem cells towards erythrocyte lineage
-chronic renal failure= associated w/ anemia due to reduced renal production of EPO…recomb is available but expensive

3-under control of parathyroid hormone & plasma phosphate. net effect of calcitriol regulates gut calcium & phosphate absorption, and also has secondary effects in bone & in kidney

36
Q

1-overview of renal function

2-kidney & CV system

3-nephron composed of

4-tubule composed of

5-cortical nephrons

6-juxtamedullary nephron

A

1-kidney (glomerulus) filters the blood taking out a large amt of H20 & solutes

  • in tubules the kidney takes back what the body needs reabsorption
  • tubules can add a little more solute to the urine secretion
  • the final urine contains a smaller amt of H20 and solute that will leave the body

2-are interdependent

3-glomerulus & bowmans capsule & tubule

4-proximal tubule, loop of henle, distal tubule, collecting duct system

5-loop of henle dips into outer medulla

6-loop of henle dips deep into inner medulla

37
Q

1-renal circulation

2-glomerulus

A

1-renal artery–> afferent arteriole, glomerular capillaries, efferent arteriole—>peritubular capillaries (cortical & medullary loops[vasa recta])—> renal vein

2-tuft of capillaries supplied by afferent arteriole & drained by efferent arteriole (not venule)

  • tucked into closed end of nephron (bowmans capsule)—space between capillaries & start of tubule= bwmans space
  • *-collects the filtrate from the capillaries**
38
Q

1-Juxtaglomerula Apparatus

2-macula densa

3-extraglomerula mesangial cells

4-key point of juxtaglomerula apparatus (JGA)

A

1-formed where thick ascending limb passes through the angle formed by the afferent & efferent arteriole of nephron
—macula densa & renin producing cells in afferent & extraglomerula mesangial cells

2-specialized cells of thick ascending
-cells respond to changes in tubular flow of NaCl and send signals to afferent arteriole that affect BF & filtration:::Tubuloglomerular feedback—comm. between macula densa to glomerular arteriole

3-cells participate in trasmitting info from macula densa to afferent & efferent arterioles

4-site of renin release

39
Q

Control of Renin Release
1-Affected by

2-from sympathetic

A

1-renal sympathetic nerves (inc SNA inc renin release)

  • pressure in renal afferent arteriole (direct mechanical effect on vascular wall= renal baroreceptor) low pressure= inc renin release, high pressure= dec renin release
  • signals from macula densa= inc or dec renin release

-renin catalyzes formation of angiotensin 2= aldosterone synthesis in adrenal cortex, both are invovled in H20 & Na balance

2-affects:

  • arteries, afferent/efferent arterioles= vasoconstriction: neurotrans NE will vasoconstrict at alpha adrenergic
  • juxtaglomerula apparatus JGA= SNS stimulates release of renin from granular cells of afferent/efferent arterioles
  • renal tubules= SNS enahnces Na reabsorption via alpha receptors
40
Q

1-mesangium

2-proteinuria

A

1-mesangial cells & mesangial extracellular matrix

  • cells surround capillaries, give structural support, secrete prostaglandins/cytokines, & are phagocytic
  • deposition of immune complexes in mesangial area= mesangial cell inflam response= glomerular scarring (sclerosis) & loss of glomerular function
  • severe loss of glomerular function= renal failure= dialysis/transplant

2-protein in urine

  • small amounts of protein in urine exist=protein dipstick
  • larger amts of protein = concern~ renal damage, systemic endothelial cell dysfunction
  • -can promote tubular/interstitial inflammation, ischemia & fibrosis
  • excessive loss of protein in urine= hypoalbuminemia= peripheral edema & alter acid-base balance and circulating levels of hormones
41
Q

1-ultra structure of glomerulus

2-endothelium

3-basement membrane

4-podocytes & slit diaphragm

5-key pt

A

1-endothelium, basememnt membrane, podocyte foot process/slit diaphragm
-filitration barrier

2-fenestrated & has negatively charged glycoproteins
-no size barrier to plasma proteins

3-composted of extracellular protein matrix, neg charged

4-cell foot processes= neg charged, interdigitate to cover BM
-gaps between foot process= filtration slits are covered by thin, selectively poroud, neg charged membrane called slit diaphragm
-component of diaphragm= nephrin
pores in diaphragm pass H20 & electrolutes but restrain medium to large proteins (albumin & IgG)

5-glomerular capilalry barrier= filter on basis of molecular size & charge. many plasma proteins are resticted from passing through normal glomerular capillary wall

42
Q

1-size & charge selectivity of glomerular capillary wall

2-glomerular proteinuria

3-albumin

4-loss of glomerular size selectivity

A

1-glomerular barrier easily passes molecules that are <20A in radius= H20, electrolytes, glucose, urea
-barrier restricts anything bigger than 42 A—easy of passibility between 20-42A depends on size & charge (barrier= negative) so cationic > anionic

2-excessive amts of medium to large plasma proteins in urine= change in function of glomerular barrier

  • maybe physiologic or pathologic
  • transient or permanent
  • loss of massive quant of plasma protein if barrier is severely compromised

3-plasma proteins as marker of glomerular cpaillar wall integrity—has radius of 36A but is negatively charged which will reduce permeability even tho its small
-loss of glomerular charge/size selectivity= inc filtration of albumin & inc in albumin in urine

4-allows large proteins to get into tubulues
-inc amt of proteins >42A like IgG (55A) will go into tubules and into urine

-most glomerular diseases= size & charge alterations of glomerular capillary wall

43
Q

1-normal urinary protein excretion/24 hrs

2-microalbuminuria

3-non-nephrotic proteinuria

4-nephrotic range proteinuria

A

1-<150 mg= albumin (<20 mg/day), other plasma proteins, & proteins derived from renal tubule & urogenital tract
-typical urinary dipstick used for screening urine for protein doesnt detect level of protein in urine, mostly detects albumin

2-albumin excretion= 30-300 mg/24 hr

  • vascular dysfunction & risk for inc cardio morbidity esp if patients have diabetes or hypertension
  • special dipstick

3-total protein excretion of less than 3 g a day
-normal dipstick

4-very large amt of daily total protein loss <3 g a day
-found w/ excessive amt of cast-off tubular cells, RBCs, & lipiduria. may have peripheral edema if there is hypalbuminuria

44
Q

1-tubular proteinuria

2-overflow proteinuria

3-exercise proteinuria

4-orthostatic proteinuria

A

1-when proximal tubule is damaged

  • most of filtered protein is reabsorbed in proximal tubule by endocytosis (usually beta 2 microglobulin)
  • but if imparied (hypoxic damge, metal intoxication, or immuno) then the person will excrete large amts of small proteins like beta 2 microglobulin
  • will also excrete albumin—but cant use dipsticks

2-excessive excretion of low molecular weight proteins bc the production/filtration of protein exceeds the ability of the proximal tubule to reabsorb it.

  • excessive production of immunoglobulin light chains in multiple myeloma=overflow proteinuria
  • rhabdomyolosis & red cell lysis can = overflow pro

3-nonpath inc in protein excretion

  • strenous exercise leads to transient inc in protein excretion= resolves after few hours
  • this type of proteinuria= tubular & glomerular bc of intensity & duration of exercise

4-nonpath inc in protein excretion
-upright position inc protein excretion. nighttime or recumbent protein excretion= normal

45
Q

1-bladder

2-internal sphincter

3-external sphincter

A

1-has body (for urine) & bladder neck (connects urethra)
-epithelial lining of bladder is surrounded by SM= detrusor muscle, SM in bladder= electrically coupled and is under autonomic control

2-thickening of bladder wall at bladder neck: tonic contractile tone & isnt under voluntary control—tonic tone prevents emptying of bladder until pressure in fundus reaches critical threshold

3-composed of skeletal muscle & innervated by alpha motor neurons carried in pudendal nerve

  • volutnary control of sphincter learned after age 2
  • pudendal nerve carries sensory afferents from bladder neck & urethra
46
Q

Autonomic Innervation of Bladder

1-sacral nerves (pelvic nerves)

2-symp inenrvation (hypogastric nerve)

A

1-sensory afferents= nerves send info to spinal cord on fullness of bladder
parasymp efferents= nerves cause detrusor muscle to contract (emptying of bladder), M3 receptors. active during voiding but are inhibited during filling

2-sensory afferents: sensory on bladder fullness & sensory from bladder neck & urethra

  • *efferents**: innervate bladder neck= contraction via a receptors (faciltates storage of urine)
  • innervation of urethra via a receptors
  • also innervation of detrusor muscle via B3 receptors= mediate relaxation
  • symp activity is active during filling of bladder but inhibited during voiding
  • symp nerves dont appear to be that important to filling process
47
Q

1-miturition reflex

2-steps

A

1-spinal reflex that is substantially modified by higher brain centers. includes brainstem (pontine), hypothalamus, & cortical areas

2-as bladder fills, SM is stretched. bladder pressure increases & sacral sensory afferents are stimulated

  • –volume reaches 150 mL = mild fullness signal
  • –volume reaches 400 mL= strong feeling of fullness
  • parasymp efferents activated in response to afferent sensory= detrusor muscle contracts—if pressure wave is strong enough the internal sphincter opens & urine is fored into urethra
  • urine forced into urethra= stretching of urethra sends a 2nd signal to spinal cord to inhibit tonically actiev alpha motor neurons innervating external sphincter
  • relaxation of external sphincter occurs & voiding results
  • –contraction of detrusor muscle & ab muscles & gravity= voiding esp in females
48
Q

1-summary of micturition

A

1-bladder vol inc & stretches detrusor
-sensory afferents are activated
3-parasymp efferents are activated & trigger contraction of detrusor
4-urine forced through internal sphincter & into urethra which activates 2nd set of sensory afferents
5-tonic activity of somatic motor nerve to external sphincter= withdrawn and relaxes sphincter
6-urine is voided

49
Q

Micturition Cont.

A
  • person w/ brain function, voluntary control of miturition relflex can override afferent signals to relax external sphincter wall
  • higher brain centers regulate sensitivity of reflex
  • –sensitivity of reflex is inc when emptying bladder is desired (voluntary voiding)
  • –sensitivity of relfex is reduced when emptying of bladder isnt wanted
  • loss of cortical control of skeletal muscle will eliminate voluntary control of voiding but not the reflex
  • –residual spinal micturition reflex= abdnormal, usually simultaneous signals for detrusor & external sphincter contraction that will interfere w/ effective bladder emptying

-loss of symp nerves dont have much of an effect on bladder filling/voiding

50
Q

1-Urinary Incontinence

2-urge incontinence

3-stress incontinence

4-overflow incontinence

5-incontinence bc of transient or reversible conditions

A

1-involuntary leakage of urine
-dysfunction of lower urinary tract alone—MS, diabetes, or cancer

2-urgency—sudden need to empty bladder

  • painful bladder syndrome
  • muscarinic blockage

3-associated w/ actionst hat inc intraab pressure, sneezing, coughing, & physical activity

  • inc in intra ab pressure overwhelms ability for sphincter to stay closed
  • stress & urge occur together in middleaged/ older women

4-inability to completely empty bladder

  • large volumes= continuous, small amts of leakage (dribbling)
  • bladder outlet obstruction—bening prostatic hypertrophy or pelvic organ prolapse
  • poor detrusor muscle contractility or underactivity = damage to parasymp afferents/oefferents
  • hesitancy in getting stream started
  • side effect of antimuscarininc (cholinergic) therapy

5-not traced to physiologic or structural problems
-UTI, excessive inc in urine production (diabetes/ excessive fluid intake), patients mobility, medications & cognitive function

51
Q

Summary of

1-urge incontinence

2-stress incontinence

3-overflow incontinence

4-incontinence bc of reversible/transient conditions

A

1-urgency—need to empty bladder

  • detrusor overactivity
  • anticholinergics as treatment

2-inc intra ab pressure

  • cough, sneeze, activity
  • insufficient urethra sphincter structure or control

3-inability to effectively empty bladder

  • large volumes = continuous leakage
  • detrusor underactivity
  • bladder outlet obstruction
  • detrusor underavtivity
  • can be side effect of anticholinergic

4-excessive urine production

  • UTI
  • imparied mobility or cognition
  • medication side effect
52
Q

1-function of kidneys

2-filtration

3-reabsorption

4-secretion

5-excretion

6-conc & dilution

A

1-volume & composition of extracellular fluid

2-removal of dissolved substances (solute) & H20 from plasma—glomerulus is the filter

3-recapturing filtered solute & H20…returned to plasma—process occurs in tubules

4-movement of solute from peritubular capillaries into the tubules—some substances are both filtered & secreted

5-excretion- removal of solute and water from body in urine—solute gets into urine by filtration/secretion

6-determines whether urine will be hypo/iso/hyperosmotic

53
Q

Glomerular Filtration Rate- Biophysical basis

A

GFR= Kf * Net ultrafiltration pressure
GFR= Kf * (delta P - delta oncotic pressure)
GFR=Kf * [(Pgc- Pbs) -(pigc -pibs)]

kf= hydraulic permeability x SA (glomerular capillary filtration coefficient)
pgc= glomerular capillary hydrostatic pressure
pbs= bowmans space hydrostatic pressure
pigc= glomerular capillary oncotic pressure
pibs= bowmans space oncotic pressure
GFR= Kf * net ultrafiltration pressure
rate at which fluid is removed from plasma by nephrone= single nephron glomerular filtration rate (SNGFR)
-but clinically we measure 2 kidney GFR= GFR—defined as sum of all of single nephrone filtration rates in both kidneys—ml/min or L/24 hr

54
Q

1-whats special about filtration in the glomerular capillaries

A

1-bc filtrate is nearly protein free, oncotic pressure in bowmans space is essentially 0
2-oncotic pressure in capillaries rise as plasma moves through capillary since protein is retained
3-capillary hydrostatic pressure shows a slight decling along the capillary
4-Kf= 100x greater in glomerular than systemic capillaries, while hydrostatic pressure is 2x greater
5-filtration occurs over length of capillary loop—no reabsorption of fluid occurs in these capillaries
6-high rate of filtration due to very high Kf
kf= intrinsic permeability of flomerular barrier to movement of fluid & SA available for filtration

55
Q

1-renal clearance-background

A

1-what goes in must come out…mass balance or conservation: INPUT= OUTPUT
for kidney= any substance that is neither synthesized or metabolized by kidney, rate of delivery of a substance (INPUT)= excretion (OUTPUT1) + return to circulation (OUTPUT2)

  • when leaves body: Excretion of X= Urine Conc of X(Ux) * Urine Flow Rate (V)
  • excretion normalized for plasma conc yields the clearance of the substance from the blood
56
Q

1-concept of renal clearance of substances from blood

2-clearance definition

A

1-substance is neither metabolized by peripheral tissues or by kidney, calculate the rate at which the substance leaves arterial blood and is excreted via urine by calculating clearance of substance from arterial blood

  • substance can leave blood via filtration/secretion
  • may reenter blood via reabsorption from renal tubules—clearance= net rate of loss from blood

Cx= (Ux * V)/Px
Clearance ml/min= (urine conc mg/ml * urine flow ml/min)/ plasma conc mg/ml

2-clearance is the ml of blood plasma completely cleared of a given substance in 1 min

57
Q

1-Clearance

2-how can it be used to measure GFR

A

1-most substances cleared from plasma by kidneys, only a portion is actually removed & excreted in a single pass through the kidneys

  • clearance of a substance is typically less than renal plasma flow
  • important bc clearance can be used to measure the GFR & Renal Plasma Flow RPF
  • clearance can be used to determine whethere there is net reabsorption or secretion of a freely filtered substance

2-clearance of a substance Y can be used to measure GFR if the substance is not metabolized by the kidney, it is freely filterable, is neither secreted nor reabsorbed

  • amt of Y excreted must equal the amt of Y filtered (filtered load)
  • –filtered load= GFR * Plasma Conc Y
  • –Excretion= Urine Conc Y * Urine Flow Rate V

solve for GFR= (U*V)/P

58
Q

1-what is “y”

2-creatining clearance as estimage of GFR

A

1-substances used to measure/estimate GFR via clearance =
insulin= plant sugar (infused w/ IV)—gold standard
—125 iothalamte or nonradioactave iothalamate
—measurement of GFT but may not be available
& creatinine= endogenous protein from skeletal muscle
—estimate of GFR

2-cretinine is produced at a constant rate by skeletal muscle and rate is proportional to muscle mass

  • creatining clearance= estimate & not a true measure of GFR bc small amt is secreted into tubulues in a normal kidney
  • secretion inc when serum creatining rises (as w/ dec in GFR)
  • creatining clerance often overestimates the true GFR in patients w/ chronic renal disease
59
Q

1-Stage 1 kidney damage
2-stage 2 kidney damage
3-stage 3 kidney damage
4-stage 4 kidney damage
5-stage 5 failure
6-GFR

A

1->90 ml/min —normal/elevated GFR

2-60-90 ml/min—mild dec GFR

3-30-60 ml/min—moderate dec GFR

4-15-30 ml/min—severe dec GFR

5- <15 ml/min or on dialysis

6-GFR decreases w/ age y

60
Q

1-creatinine clearance vs prediction equations for GFR

2-cockcroft gault formula

3-CDK-EPI and MDRD study equations for adults

4-prediction equation variables

A

1-24 hr colelction of urine measures creatinine clearance

  • measuring clearance to assess GFR is not more reliable than estimating GFR from a prediction equation
  • resultant values for GFR = eGFR to distinguis value from direct measurement of GFR w/ exogenous marker substance like insulin

2-older equation & still used in practice, drug dosing: C creat= (140-age) (body weight kg)/ (72)(serum creatining in mg/dL)

for women multiply value by 0.85

3-estimate GFR for patients w/ GFR <60 ml/min
CKD EPI= better MDRD w/ GFR>60
-limited by the small number of samples from the elderly population & ethnic populations other than white/black
eGFR equation for japanese adults
-serum conc of small protein called cystatin C into creatining based equation

4-serum creatinine, age, sex, white/black

61
Q

1-plasma creatinine & GFR

2-why serum creatinine= insensitive indicator of GFR at mild/moderate levels of renal insuffiency

A

1-absence of major changes in diet or muscle damage, release of creatinine from skeletal muscle is constant—1.8 g/day. inverse relationship between plasma creatinine & GFR…if GFR dec & creatinine production is constant, then plasma creatinine must inc
—if patients Pcreatinine rises from 1-2 mg/L over time, then GFR has dec
however at mild/moderate levels of renal insufficiency, serum creatinine may not inc much—serum creatinine= insensitive index of clinically relevant changes in GFR in mild/moderate renal insufficiency

2-bc kidney inc the secretion of creatinine when serum creatinine begins to rise so serum creatinine doesnt truly reflect imbalance between filtration of creatinine & production of creatinine at mild to moderate levels of renal disease
-once tubular transporter for creatinine is saturate the relationship between GFR and plasma creatinine becomes tighter & rapid inc in plasma creatinine will result of further dec in GFR

62
Q

1-clearance of PAH—estimate of RPF

2-renal blood flow split into 2 components

A

1-PAH is cleared from blood in 1 pass through kidney
-tubule has large capacity to secrete PAH
excretion of PAH in urine= entry via RPF
-thus clearance of PAH (ml/min) from kidney is as estimate of RPF (ml/min)

2-Renal Plasma Flow (RPF) & RBC (hematocrit)
—plasma is filtered, RBCs arent
-can measure RPF using clearance of a substance that is completely removed in ONE PASS through kidney—para-aminohippuric acid or PAH
-PAH is removed from the plasma by filtration & secretion into proximal tubulue—as long as secretory mechanism isnt overhwhelmed then nearly all of the PAH entering the kidney will be excreted
Clearance of PAH in ml/min= renal plasma flow in ml/min

63
Q

1-filtration fraction FF

2- how to tell if freely filtered substance is secreted or reabsorbed

3-protein-bound solutes & filtration

4-filtered load of a protein bound solute

A

1-GFR/RPF—portion of plasma that is filtered: normally FF= .15-.2

  • higher filtraction fraction, the greater the fraction of plasma that is filtered= more solute available for excretion
  • filtration fraction can change bc GFR & RPF can change independently of the other

2-measure the clearance & compate to the GFR(clearance of creatinine)

  • substance has a clearance >GFR= X is secreted
  • substance has clearance < GFR= X is reabsorbed
  • substance cannot have a clearance greater than renal plasma flow

3-substance is plasma protein boun—not available for filtration…endogenous compounds, such as steroids or thyroid hormone or exogenous compounds

4-100% protein bound—none of the solute will be filtered

  • solute is only partially protein bound then only the fraction of the solute that is free in the plasma is available for filtration
  • drug that is highly protein bound will stick around (longer 1/2 life) in the circulation longer than a drug that is poorly protein bound
  • if fraction of drug that is protein bound changes, then filtration and clearance of drug from circulation can change as well
  • –filtration of Y is less bc its bound to albumin= highly restricted from crossing glomerular wall
64
Q

1-get change in GFR

2-changes in afferent arteriolar resistance

3-changes in efferent arteriolar resistance

Starling Forces

4-change in Kf

5-Change in capillary oncotic pressure pigc

6-change in bowmans space hydrostatic pressure Pbs

A

1-regulated by changing capilalry hydrostatic pressure (Pgc or Pc) changes in Pgc are mediated by changes in glomerular arteriolar resistance

2-dec resistance= inc Pgc & GFR
inc resistance= dec Pgc & GFR

3-dec resistance= dec Pgc & GFR
inc resistance= inc Pgc & GFR

—inc/dec in systemic BP will transiently inc/dec Pgc & GFR

4-dec in Kf= dec GFR
inc Kf= inc GFR

5-change in plasma albumin
dec pigc= inc GFR
inc pigc= dec GFR

6-obstruction of urinary tract—kidney stone
inc Pbs= dec GFR

65
Q

1-regulation of GFR & RBF

2-change in afferent arteriolar resistance

3-change in efferent arteriolar resistance

4-clinical

A

1-symp nerves, epinephrine & number of hormones affect GFR & RBF via alterations in arteriolar resistance

2-GFR & RBF change in same direction when afferent arteriolar resistance is changed

  • –constriction (inc resistance) of afferent will result in dec in GFR & RBF
  • –dilation (dec resistance) of afferent will result in inc in GFR & RBF

3-GFR & RBF change in opposite direction when

  • –constriction of efferent= inc GFR & dec RBF
  • –dilation= dec GFR & inc RBF

4-hemorrhage (loss of blood volume)—> inc in symp—>constrict afferent & efferent= dec RBF & GFR—> dec in filtered load of Na & H20—>dec in Na & H20 excretion

66
Q

regulation of RBF & GFR by nerves/hormones

1-symp nerves

2-angiotensin 2

3-angiotensin 2 synthesis

A

1-innervate both arterioles & are tonically active at a low level
—strong activation of renal nerves will decrease RBF & GFR
stimuli= fall in BP, fear, pain, heavy exercise

2-produced locally in kidneys, and systemically (circulation)
-in peripheral circulation, Ang II binds to At1 & At2 receptors
AT1 receptors predom and are responsibly for hemodynamic & renal effects of Ang 2
Selective Ang 2 receptor antagonists are a class of antihypertensive drugs

3-renin catalyzes formation of AngI which is converted to Ang2 by enzyme angiotensin converting enzyme or ACE. Renin is produced and stored by specialized SM cells in afferent/efferent arterioles
-renin release is stimualted when ECF volume or BP are low
-dec in ECF V or BP= dec in renal perfusion pressure (afferent arteriole) [goes to renin release & inc angiotensin 2]
and activation of symp NS (beta 1)

67
Q

Renin Release Affected By
1-renal perfusion pressure

2-beta 1 agonists

3-macula densa

A

1-afferent arteriole senses pressure (renal baroreceptor) and releases rening when pressure falls & inhibits release of renin when pressure is elevated

2-like renal nerves NE & epi. agonists will inc renin release. rening release is sensitive to low levels of renal SNA

3-volume depletion or renal vasoconstriction lowers GFR—resultant dec in tubular conc of NaCL at macula densa results in a signal to release renin from afferent arteriolar cells

68
Q

1-renal hemodynamic effects of angiotensin 2

A

1-ang 2 supports GFR when RPF dec

  • Ang 2 has a greater effect on efferent arteriole which prevents excessive dec in GFR when RPF or systemic BP dec.
  • GFR may be lower but it is higher than expected for the level of RPF
  • more sensitive w/ efferent bc Ang 2 inc production of vasodilators in afferent arteriole so by raising efferent arteriolar resistance= inc filtration fraction, ang 2 help prevents excessive dec in Pgc & GFR under volume contraction or dec BP
  • –ang 2 promotes Na & H20 reabsorption
  • –coordinated actions of Ang 2 promote filtration of solute (like urea) must still be excreted under conditions of ECF contraction w/o unnecessary loss of Na and H20
69
Q

1-renal artery stenosis

2-renal hemodynamic effects of NO (endothelial factor)

3-NO release stimulated by

A

1-Ang 2 supports GFR when RPF dec—low pressure in afferent arteriole stimulates renin releases= ang 2 production
constriction of efferent arteriole maintains Pc & GFR

2-gaseous substance that is generated in the endothelial cell via action of NO synthase enzyme on AA arginine
NO plays imp vasodilatory role in kidney under basal conditions
NO counteracts vasoconstriction produced by angiotensin 2 and vatecholamines (NO keeps RBF from going TOO low)

3-shear stress acting on endothelial cells (inc when vessel diameter dec) &&& acetylcholine, bradykinin, ATP, histamine
—inhibition of NO = inc basal tone & inc vasoconstriction (via catecholamines & angiotensin 2)

70
Q

1-pathogenisis of diabetes nephropathy

A

1-renal failure due to diabetic nephropathy affects roughly 1/3 diabetic patients. diabetes= imp cause of renal failure in industrialized nations

  • diabetes= afferent arteriolar dilation= elevated NO production in afferent artiole= excessive vasodilation
  • –vasodilation of afferent arteriole= inc capillary pressure= inc GFR
  • –high capillar pressure (glomerular hypertension) promotes glomerular damage & contributes to dec in renal function
  • angiotensin 2 blockade to reduce glomerular hypertension
  • –inc glomerular capillary pressure Pgc which damages glomeruli
  • in kidney lowering Ang 2 action on arterioles via ACE inhibitors or AT1 receptor blockers will preferentiall decrease efferent arteriolar resistance= dec Pgc

ACE inhibitor and/or AT1 receptor antagonists dec systemic BP which also dec Pgc
ACE inhibitors or Ang 2 receptor blockers= slow progression of diabetic renal disease

71
Q

1-mechanisms by which lowering ang 2 levels or blocking At1 receptors slow progression of diabetic renal disease

2-renal hemodynamic effect of prostaglandins PG

A

1-reduce efferent arteriolra constriciton= help lower glomerular hydrostatic pressure
2-lower systemic BP
3-reduce proteinuria= proteinuria can initiate tubular inflammation & scarring
4-reduce production of cytokines (cell signaling chemicals) that initiatte mesangial & tubular scarring

2- PGs are derived from lipid (arachidonic acid) in cell membrane. cyclooxygenase (COX 1,2) enzymes are targeted by aspirin & NSAID (ibuprofen) class of drugs

  • –PGE2, prostacyclin (PGI2)—vasodilators
  • –Thromboxane A2;PGF2—vasoconstrictors
  • vasodilatory PG production is stimulated bc dec ECF volume, inc angiotensin 2, symp nerves & stress
  • –vasoconstrictor factors stimulate production of vasodilatory PG
  • –PG minor role in hemodynamic in healthy individuals under stressful conditions PGs counteract vasoconstrictor effects of catecholamines & Ang 2…preventing harmful degress of vasoconstriction. (renal ischemia)
72
Q

1-prostaglandins & pathophysiologic conditions

2-bradykinin

A

1-patient w. compromised RBF, GFR, inc vasoconstrictor production (Ang 2), inhibition of vasodilatory PG production w/ non steroidal anti inflam drugs (NSAIDS) can precipitate a rapid dec in GFR

  • vasodilatory PG work at afferent arterioles so removal of PGs will cause unopposed afferent arteriolar constriction, reducing RBF & GFR
  • vasodilatory PGs maintain adequate GFR & RBF when renal vasoconstrictors (Ang 2, catecholamines, renal SNA) are elevated

2-vasodilator that works by stimulating release of NO & PG from endothelial cells

  • bradykinin inc GFR & RBF
  • angiotensin converting enzyme ACE breaks down bradykinin
  • part of BP lowering & renal vasodilatory effects of ACE inhibitors have been attributed to enhanced bradykinin levels
73
Q

Summary
1-vasoconstrictors

2-vasodilators

3-autoregulation of GFR & RBF

A

1-NE (symp nerves) & epi
angiotensin 2
vasoconstrictor PG (thromboxane & PGF2a)

2-Nitrix oxide (NO)
bradykinin
PGI2 (prostacyclin) PGE2

3-BP fluctuates (orthostatic changes, exertion, eating, sleeping)

  • autoregulation by kidney avoids wide swings in fluid & solute excretion caused by arterial pressure fluctuations (GFR & RBF constant over an arterial pressure of 90-180 mmHg)
  • below 90= RBF & GFR follow arterial pressuer
  • autoregulation isnt perfect…can dampen influence of hormones & symp activity on RBF & GFR

1507 (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions