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Urinary System (Fluid and Electrolytes)

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christine ceblano

on 1 May 2016

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Transcript of Urinary System (Fluid and Electrolytes)


Urinary System
Christine A. Ceblano
2 May 2016
Fluid and Electrolytes
pelvis
pyramid
calyx
HILUM
sinus
papilla
2-3 major
tiny opening
apex
base
renal PARENCHYMA
a
A----
i
V---
----
L: higher than R
fist: size (1, 2-3, 4-5)
bean-shaped
punch: Murphy's kidney punch
// @T12-L1 retroperitoneal
kidney
punch
(ultrafiltration)

(erythropoietin)
(cavity)
N------
r A-----
r V---
E
N
A
L
R
FUNCTION
emove wastes
quilibriate electrolytes
ormalize BP
cidify/alkalinize blood
iberate hormones and glucose
color
system
Kidney
striated
(t-----s &
v-----s)

functional unit
lymphatic v

nerves

R e
nal
S eg
mental?
I nter
lobar
A rc
uate
I nter
lobular
20-25% CO
1200 ml/min
R
s
I
A
i

STRUCTURE
FUNCTION
5. what is the normal
urine pH?
6-10. List the main functions of the urinary system?
1. What is the functional unit of
the kidney?
2. Which blood vessels supply blood to the glomerulus?
3. What do you call the cone-shaped striated brown-red portion of the kidney with dense concentration of tubules and vessels?
4. Interpret the arterial
blood gas of:
pH=7.38
pCO2 = 49
HCO3 = 12
paO2 = 91
KUB u
size
shape
location
L --- R
_? M per kidney, constant
RENAL CORPUSCLE
(sac-like)
Bowman's capsule
filtration
contains ~50 capillaries
@cortex
CORPUSCLE
renal
renal
MEDULLA
renal
renal
renal
afferent
renal
ef
efferent
arteriole
arteriole
renal
renal
TUBULE
.
[PCT]
[DCT]
[desc
LOH]
[asc
LOH]
[CD]
corpuscle
renal
ions
nutrients
CHON
in:
Na+
Cl-
Ca+2
Cortical
Juxtamedullary
nephrons
nephrons
a. location of renal corpuscle
(+renal tubules)
b. size of loop of Henle
C
A
P
S
U
L
E
TYPES
Juxtaglomerular
apparatus
juxtaglomerular
secretes
cells
macula

densa
senses fluid flow,
Na+ concentration
renin
size
location
Blood Supply to Kidney
KIDNEY
Description
KIDNEY PORTION
Blood Supply
inside the Kidney
renal plexus
SNS
parts
kidney
made
EASY:
reab-
sorption

secretion
URETER
of kidney
renal
tubule
plasma
=
filtrate
+
NEPHRON

Made Easy
P
De
D
Al
C
o
l
l
x
n
C
E
B
M
G
E
Plasma
Glomerulus inside
physical barriers
of filtration
(from pelvis)
(muscular peristaltic wave)

P
(movement)
(outer)
(inner)


push
filtration
M: @posterior--rectum
F: @anterior--uterus&vagina

b. full
(many folds)
a. empty
c. distended
(smoother)
(push above pubic crest)
TRIGONE
3 openings
apex - anterior
base - posterior

Prostatic
Membranous
Penile
urethra
pressure
Urine output: 600 cc - 2 L/day
50 ml/hr
0.5 - 1 cc/kg/hr
Fluid intake
environmental temp
T
RR
emotion
body
humidity
arterial blood gases
Normal Values
pH
pCO2
HCO3
[7.35
-
7.45]
[22
-

26 (or 28)]
[35
-
45]
Na+
Cl-
Ca+
HCO3
-
HPO4-2
Distribution
K+
Mg+
[135-145]
[8.5-10.2]
[3.5-5]
[1.5-2.5]
[95-108]
[22-26]
[1.7-2.6]
Cations
Anions
Proteins
PRINCIPAL [Electrolytes]
(blood volume)
(electrical impulses)
(muscle contraction)
all @renal
Insulin
K+ incell
glucose
(electrical impulses <3, N)
(muscle function <3, s, s)

(bones, teeth)
(cardiac pacemaker)
(blood clotting)
(nerve impulses)
Calcitonin
(move along with Na+ -> blood volume)
(HCl production)
buffer (1. Acid-base; 2. O2-CO2 exchange in RBC)
reciprocal
(bones, teeth)
(macronutrient metabolism)
(cellular metabolism: produce ATP, DNA)
(muscle, nerve, RBC)
(acid-base balance)
(regenerate by kidney)
(major buffer for acid-base balance)
Angiotensin
I
ACE
Angiotensin II
Aldosterone
Na+ from DCT & CD
plus Cl-
K+ out
releases:
vasoconstriction
ADH
Renin
aquaporins
Glomerulus
*oliguria
*anuria
*polyuria
*ketonuria
*bilirubinuria
*bacteriuria
/UTI
fluid balance: intake = output
*normal
*negative
*positive
urine pH
Acid Normal Alkaline
pH
Acidosis
Diarrhea
Starvation and dehydration
DM, uncontrolled
Respiratory diseases in which carbon dioxide retention
Urinary tract obstruction/ UTI
Pyloric obstruction
Salicylate intoxication
Renal tubular acidosis
Chronic renal failure
Respiratory diseases that involve hyperventilation
meat, cranberries, orange, milk
citrus fruits, legumes, vegetables


300 mOsm/L
E
(adipose
capsule)
(renal
fascia)
in (-to blood):
AA
CHO
Na+,K+,Cl-, HCO3-


out:
H+
NH4+
Urea
Crea


in:
Na+,K+,Cl-,HCO3-,
Ca+2, Mg+2,
H20

out:
urea
in:
Na+, HCO3-,
Urea

out:
K+
H+
(electrical, <3, N
muscle function)


PTH
Ca+ inblood
HPO4-2 out
6
>=7.5 or 8
<=5
pCO2
HCO3
POSSIBLE ABG INTERPRETATION
HIGH
LOW
Respiratory Alkalosis
(i.e. hyperventilation, anxiety)
Metabolic Acidosis
(i.e. ketoacidosis, lactic acidosis, renal failure)
Respiratory Acidosis
(i.e. Hypoventilation, Smoking,
Chronic Obstructive Pulmonary Diseases)
Metabolic Alkalosis
(i.e. vomiting, diuretics, hyperaldosteronism)
a. no buffering between pCO2 and HCO3: "uncompensated"
b. if there's buffering between pCO2 and HCO3:
b1. if the compensation makes the pH within normal range: "fully compensated"
b2. if the compensation does not normalize the pH: "partially compensated"

Prefix:
[Quiz: fully compensated respiratory alkalosis]
D
Glucose-6-Phosphatase
(gluconeogenic enzyme)
renal cortex secretes:
pancreas secretes:
glucose
@PCT: reabsorption of glucose via glucose transporter proteins
pH=7.38 pCO2 = 25 HCO3 = 32

punch
COLUMN
C
O
R
T
E
X
renal
(collagen
cover)
has 5-18
hello
renal LOBE
Aa
Ea
J
M
Aa
Ea
Filtration
BP regulation
UF
UF
UF
(chamber)
8-14 minor
(smooth muscle)
suprapubic
22–30 cm long
internal
urethral
sphincter
D------r muscle
(1.5 in)
(8 in)
250 ml
500 ml
signal
capacity
urine: 1-2 L/day
Electrolytes
fluid compartment?
mEQ/L
Hormones
rythropoietin
R
Angiotensin
v----------
PP
epo-producing fibroblasts
activation
D3, D2
stimulates conversion into calcitriol in kidney
tubular reabsorption of Ca++
too much PTH ->
Calcitriol
Urine
0-5/HPF
0-3/HPF
RBC
can be caused by diet:
*pineapple may fall into alkaline
Full transcript