anatomy 2 Flashcards
kidneys
Wilms’ tumor
kidney tumor assoc. with aniridia
kidney functions
acid base balance, controling Na (&H20) excretion and thereby also controling BP, eliminate waste like urea, uric acid and creatinine, PRODUCE erythropoietin and vitamin D3, degrade insuline and PTH
what % of body weight is water?
60%
what % of body weight is INTRA-cellular
40%
what is in EXTRA-cellular body fluid?
20% and has interstitial fluid, plasma, transcellular, NaCl and NaHCO3
what is macula densa and where is it?
MD monitors fluid composition @ tubular lumen at the JG apparatus (in front of Lacis cells)
what are lacis/ extraglomerular mesanglial cells?
they lie behind macula densa layer at the entrance near Bowman’s capsule–transmit info from macula densa to the granular cells
what are granular cells? aka JG cells?
smooth muscles with epi appears @ AFFERENT arteriole near glomerulus–synthesize renin (vasoconstrictor when low BP)
when do JG cells produce renin?
beta-1 adrenergic stimulation, JG detected low renal perfusion P-meaning when there’s low fluid P at JG, and low NaCl re-absorption by the macula densa due to a low GFR
what is the equation for urine formation?
excreted: filtered - reabsorbed + secreted
what is the quation for renal clearance in word form?
clearance= (urine concentration * flow rate) / plasma concentration—measured in RATIO to clearance of INULIN (same as GFR)
what does it mean to have a LOW clearance? less than 1
low Clearance ratio= need MORE of it in the body= increase reabsorption of product
why do we use inulin for GFR clearance? what’ a normal value?
inuline= fructose polymer that just stays in the tubule and goes to pee, nontoxic and normal= 110-125mL/min
what is GFR?
rate at which plasma is filtered (out into bowman’s and into Prox. tubule) by the glomeruli
what is creatinine? how’s it related to GFR?
from creatine phosphate and is always stable in blood unless there’s disease. has INVERSE relationship w/ GFR
what does high creatinine clearance in pee mean?
good, efficient kidneys! they are working well to maintain stable plasma creatinine levels. low PLASMA creatinine= good filtration= high GFR!
name something that should NOT be in urine?
glucose, protein, AA, RMC, WBC, bilirubin, ketones (acidosis)
what is glucose TH for diabetics?
over 200+mg in pee= diabetic
what type of diabetes is likely in someone with ketones in their urine?
type 1
what is bilirubin?
yellowing in brusing, from break down of blood. Usually means liver problem, but can be in newborns who are making too much RBC and liver is killing off the excess so there’s increase in bilirubin–that’s normal
what % of cardiac output goes to renal blood flow? what is that in L/min?
20% – 1.2L/min
assuming HIGH BP, what is the myogenic mechanism?
Ca channels open and contract smooth vessel walls which decrease the diameter= vaso-CONSTRICTION= increases resistance to “brace” for the high BP
assuming HIGH BP, what is the tubuloglomerular feedback?
highBP= higher GFR to help get rid of some fluid to decrease the P. This happens with ATP released @ macula densa via adenosine release—a vasoconstrictor at the local level (also stops reninproduction which is for low BP)
what are some vasoconstrictors?
renin during low BP, adenosine during high BP, angio2 @ lungs, thromboxane for hemostatis, vasopressin
what are some vaso-dilators?
dopamine when happy/relaxed, histamine, prostaglandins, kinins
what do the JG cells have that allow it to control what goes in/out? how?
has podocytes w/ food processes on the VISCERAL layer that work with endo. fenestrations/pores (RBC’s can’t leave cuz of this). slit membranes on the apical side facing Bowman’s Space prevent mid-size proteins leaving, Basal lamina (middle layer, BM) prevents large proteins from leaving
what is the net filtration P? and what are the average values in and out?
net= 10mmHg, with 55= capillary P pushing OUT, and P of bowman’s + colloid osmotic P pressing ON capillaries= 45—55-45=10
what is filtration fraction?
% of plasma flowing through the kidney’s that’s filtered–20%
what is going OUT of prox tubule and into the prox. cells to be reabsorbed to blood?
NaCl w/ water passively following, bicarbonate, glucose, AA, proteins, phosphate, Cl (exchanging base)
@ prox. tubule, what’s going out of cell and INTO BLOOD ultimately?
Na (via Na/K ATPase pump), K& water passively, glucose, AA, P, Cotransport: Cl&K, Na & HCO3
what’s going OUT from blood into urine @ prox. tubule?
H+ and base
what’s an INHIBITOR @ prox. tubule? what will decrease reabsorption?
carbonic anhydrase= acetazolamide (diuretic)—decrease HCO3 resorp.= decrease Na resorp= water goes to pee!
what happens at DESCENENDING loop of henle?
only water leaves tubule to go towards blood (impermeable to NaCl)
what happens at ASCENDING loop of henle?
water cannot do anything here. NaCl &K all cotransport out to blood via Na/K ATPase
what is a INHIBITOR @ascending limb that blocks the NaCl&K cotransport? what disease can happen from this?
diuretic furosemide= increase EXCRETION= more pee with less resorption—can lead to hypokalemia= low K
what happens at distal tubule?
unless there’s Aldosterone from adrenal glands or ADH water will not do anything here. mostly just Na, Ca (passive into cell, active to blood) and Cl cotransport to blood
what hormone enhances the Ca channel to increase Ca absorption?
PTH parathyroid
what INHIBITS @ the distal tuble…stopping NaCl cotransport to blood?
diuretic (thiazide)= more pee!
what happens at he collecting duct?
Primary: K regulation via Na/K ATPase out of blood & passive to the tubule
what is the 2ndary action at the collecting duct during acidosis? via ____ cell?
intercalated cells that adjust during ketoacidosis (too much acid in blood)–H/K ATPase @ lumenal membrane—excrete H+ and keep HCO3 and K in blood
what is the mechanism for urinary concentration?
counter-current @ medulla: opposite fluid flow in adjacent structures.
what type of counter-current is the loop? what about the vesa recta?
loop= CC multipliers
vasa recta= CC exchangers (reduce dissipation of solute gradient)
which part of the tubule re-absorbs most of urea?
prox. conv. tubule
as water is reabsorbed, urea is ___? resulting in ___ urea @ inner medulla?
more water in body= more urea in pee
where does the ADH act on? what does it do?
ADH= vasopressin and acts on cortical collecting to make them water permable= increase water retention
where is urea IMPERMEABLE?
- ascending limb of loop
- DCT
- outer collecting tubule
what is diabetes insipidus?
even tho you drink less water, you still excrete highly diluted urine= polyuria
what is cranial Diab. Insipidus?
low ADH release from post. potuitary
what is nephrogenic diab. insipidus?
ADH insensitivity by collecting ducts= water still impermeable
what is dipsogenic diab. insipidus?
excessive thirst from hypothalamus issue
how does atrial natriuretic factor affect urine formation?
atrial cells that regulate Na sense volume expansion on atrial wall causing 1. vasodilation 2. decrease aldosterone=decrease angio2= vasodilate 3. decrease renin—all leads to more Na excreted=more water excreted!
increasing K levels will ___ aldosterone levels?
increase K = increase Aldosterone= decrease BP by increasing plasma K
if a pt has diabetc acidosis, why do they have to watch K levels when using insulin treatment?
insulin promotes decrease of K levels in blood by moving them INTO cells, but you could move too MUCH out of the cell causing “hypokalemia” if they originally had too low of K levels
is it harder for body to deal with alkalosis or acidosis? why?
harder to deal with alkalosis because there is a loss of H+ which causes an increase in bicarbonate (since you can’t turn it into h2o and CO2)= body then decreases respiration to preserve HCO3 which just makes things MORE basic
does the parasymp. or the symp. system regulate micturition (urination?)
PARASYMP!! mediates internal spincter contraction and relaxation
what is the effect of atrial natriuretic factor? what type of patients are these?
bed ridden pts. heart cells sense “stretching” and more Na is excreted= more water in pee too! (leads to DIURESIS= bad)
how does aldosterone regulate kidneys?
high K in blood signals adrenal glands to produce aldosterone which keeps does water retention via Na resorption
(and K excretion)
how does Insulin affect K balance in blood/plasma?
more insulin= more K into cells and out of blood—but can cause cardiac arrest of to little K is in blood as in diabetics w/ ketoacidosis
what is the external spincter in the urinary tract innervated by?
pudendal nerve
what is the internal spincter innervated by?
hypogastric and hypogastric nerves—detrusor muscle
which rib are the kidneys covered by?
floating ribs and are RETRO-peritoneal
where are the adrenal glands in relation to the kidney?
the “hat” that’s on top and superior/medial border
90% of the blood passing throught he kidney is at ___ part of the kidney?
cortex= outer top rib area
the # of lobes of the kidney= ?
lobes= # of medullary pyramids–usually 8-10
what is the renal lobule?
medullary “rays” that are within the cortex= straight collecting tubules that stretch from the medulla upwards
what/where are the renal papilla?
where collecting ducts perforate into @ tip of medulla pyramids—where “pee” will drip out into the minor calyx into.
90% of the flow through the cortex uses __% of cardiac output?
20% cardiac output= 90% cortex flow
blood supply to he medulla is from ___ arterioles of the JG?
efferent–give rise to peritubular capillaries
what is the vasa recta?
long and straight capillaries deribed from the peritubular capillaries
if plasma glucose is greater than ___mmHg, then you will have glucose in your urine?
180mmHg plasma glucose= diabetic and will have glucose in pee
should there be more creatinine in the urine or plasma?
urine. plasma creatinine level is constant, the rest is always cleared in urine–opposite of GFR
how does endocrine kidney function produce erythropoietin? when does this happen?
when there’s low plasma oxygen levels—peritubular capillary endothelium will make more RBC
when is renin produced?
in response to LOW BP, stimulates angio to angio 1 then angio 1 to angio 2 via ACE @ lungs to raise BP
what is a horseshow kidney?
when primordial tissue does NOT split to form 2 kidneys
what developes into nephrons and parts of collecting duct?
metanephric plastema
where does the cortex/medulla/ lobes of the kidneys derive from?
ureteric bud
what are signs of polycystic kidney disease?
- bilateral
- cystic dilation of renal tubules
- autosomal dominant (inherited)
- 10% of dialysis patients
what is the association between kidney and eye problems?
- same embyogentic stages: 7-10 weeks
2. severe myopia, cataracts, Retinal pigmentation
what’s the association between polycystic kidney and plepharochalasis (eye) disease?
- inherited
- eyelid skin relaxation from intercellular tissue atrophy
how is it that urine does NOT backflow back into kidneys?
- constrictions at 3 different places:
1. end of renal pelvis& start or ureter
2. when ureter passes from abdomen to pelvis @ sacral region
3. ureter meets bladder
what type of peritoneal are the ureters?
retro-peritoneal like the kidneys
what is “incontinence?” which sex is more common?
loss of bladder control–common in women
what is “postatic hyperplasia?” which sex is more common?
benign feeling of needing to urinate–common in men because male urethra travels through prostte
what is the triad of Reiter’s Disease?
(autoimmune disease!)
- arthritis
- conjunctivitis/anterior uveitis
- urethritis
- *infection is gone by the time symptoms shows up**
what is a intravenous pyologram used for? (dye that flows through kidney& X-rayed
obstruction to flow of urine via collecting duct–check for kidney stones (nephrolith)
how is adrenal glands innervated primarily?
pre-ganglion sympathetic that go to medulla (inner section)
what does the zona glomerulosa filter? where is it?
mineral-corticoids (aldosterone)–outer zone right under the capsule of adrenal glands
what does the zona fasciculata filter? where is it?
gluco-corticoids–middle layer/cortex of adrenal glands
what does the zona reticularis filter? where is it?
androgens/hormones (estrogen)–inner ring of cortex right outside of the medulla area
what to topical/oral clucocorticoid treatment (for inflammation etc) do to adrenal system?
turns off body’s natural steroid production…so the meds need to be tappered off slowly
what is aponeurosis in the abdominal wall?
broad sheet of dense fibrous C.T. and forms attachments for various muscles
what is the name of all the RIGHT regions of the abdominal area? what does “hypochondriac” mean?
top: hypochondriac
middle: right lumbar
bottom: iliac region
- -hypochondriac”= beneath the rib
what is the order of the small intestine?
duodenum–> jejunum–>illeum
what is the order of the large intestine?
cecum–>asending colon–>transverse colon–> descending colon–> sigmoid colon–>rectum–>anus
what is the peritoneum?
serous membrane that lines the cavity of the abdomen
- folded INWARD over the abdominal viscera
- outer layer= adherent to abdomen parietal layer
- inner layers= visceral layer that invest the viscera
what is the omentum? vs. the mesentery?
omentum=connecting abdominal structures to each other (stomach, liver)
mesentery=connecting abdominal to posterior body wall–making things stick in the back
is there a lot of blood flow through the linea alba?
no, virtually no vessels here
what is the relationship between mesentery, gut, peritoneum, and blood supply?
- the peritoneum= the big circle surrounding inner organs
- retroperitoneum= space between outer body wall and the peritoneum
- mesentery= lining between aorta, vena cava, and small intestine etc. in the “inner” part of the body cavity wall
what are some organs that are RETRO-peritoneal? (behind the peritoneum)
- kidneys
- ascending/descending colon
- pancrease (most of it)
- duodenum
how is the esophagus oriented in relation to the trachea? which is in front/back?
esophagus= EATING= back trachea= BRAETHNG= front (more important, you know!)
what is a hiatal hernia? what type of people get it?
stomach protrudes TRHOUGH the esophagus hiatus (food!) of the diaghragm.
-occurs when not enough fiber comes through & obese people& women
what is the acute angle formed between the esophagus and the stomach? what is between the stomach and the duodenum (Small Intst.)
- *cardiac notch
- where food goes from “throat” to “stomach” part
- *pyloric sphincter
- the outer end of the stomach to connect to small intestines
which part of the colon is retro-peritoneal?
ascending part & descending part–NOT THE MIDDLE (transverse is peritoneal)
what body covering is the small intestine? (it’s within what layers?)
mesentery layer which is more medial
what does it mean to be retroperitoneal?
anything in the post. body wall
-pancrease (except part into the spleen)
where is the sigmoid colon? is that part of the abdomen?
sigmoid colon= very BOTTOM end of the LI, which is in the pelvic cavity–NOT abdomen
on the large intestine, what are the lobes of circular “fat” called? what is the smooth linear lining of it called? what are the lobes of the actual LI called?
fat lobes= appendices apiploicae
smooth part= tenia coli
overall lobes of LI= haustra
which cervical nerve does the esophagus run near?
C10
why does the esophagus have a “sharp angle” aka the cardiac spincter?
prevent back flow of food
where is the appendix?
where the illeum enters @ illececal valve into the cecum–veriform appendix
what are tapart enia coli?
- make up smooth/shiny part of LI
- 3 external longitudinal muscle bands
how does a stomach ulcer form? WHERE is a typical ulcer?
- @ duodenum
- H pylori produces UREASE—makes urea –> NH4 (ammonia)= damage to gastric mucosa
what does the appendix do?
immuno!
-Beta lemphocytes that help produce “good bacteria” to repopulate the gut when there’s an infection
what is characteristic of colon cancer?
bariym enema= “apple core” looking alike of the tumor growth on an X-ray
-it is twisting the bowel and restricting the lumen
what are the branches of the abdominal aorta?
- celiac artery
- renal artery
- superior mesenteric Atery
- inferior mesenteric artery
- testicular/ovarian artery
- common iliac
- -> breaks into external and internal artery at the pelvis region
appendices apiploicae do?
@ the LI and are fat lobes that store energy
what nerve pierces the diaphgram?
T-12
what is the cut off for superior mesenteric supply vs. inferior mesenteric artery supply?
- superior= goes to left colic flexure (acute)
- inferior= handles all things below it
what are the vasa recta arcades? what is special about the illeum vs. the jejunum arcades?
arcades= terminal arteries= do NOT connect with anything
-the arcades are SHORTER in the ileum (end) vs. the jejunum (middle)
what are the 4 parts of the liver donated?
-right hepatic vein/artery
-right liver lobe
-right bile duct
and right portal v
how many lobes and how many segments are there on the liver?
2 lobes,
4 segments=4 ducts to go to the duodenum
what divides the liver into its R and L parts? what ligament runs along the top of the liver?
- falciform ligament divides R & L–aligns vertically to the inferior vena cava @ top liver and the gall bladder @ lower liver
- coronary ligament
what omentum covers the liver?
the LESSER omentum
what is the ligamentum teres? where is it?
aka the “round ligament”
- remnant of the left UMBILICAL vein of the fetus–mom gives blood to baby heart
- passes superiorly in the falciform ligament
how does the hepatic portal system work?
group of veins that essentially go to the liver– go from capillary of the stomach, intestine, spleen and pancreas to the sinusoids of the liver
what % of the blood to the liver is portal-venus?
70%
-“portal”= one capillary bed to another capillary bed
what is portal hypertension?
hypertension @ portal system due to venous obstruction of occlusion
-produces splenomegaly (enlarged spleen) & ascites (fluid in peritoneal cavity) in its later stages
what are ascites?
too much serous fluid @ the peritoneal= space btwn tissues and organs @ the abdomen cavity
3 things that can go wrong in portal hypertension, what happens?-1. esophageal varicosities 2 hemorrhoids 3. umbilical varicosities (caput medusa)
- astatomotic veins where the system gets “backed up” and blood accumulates in the esophagus veins
- swollen veins @ the anal canal
- vein enlargement at the umbilicus (center of body)–aka caput medusa
what do liver function tests check?
differentiate hepattis (liver inflammed) vs. cholestasis (bile flow problem to liver)
what’s in the portal triad
bile duct + hepatic artery + portal veins
-all flow toward the center
what is the leading cause of PORTAL hypertension in US?
alcoholic and viral cirrhosis
-aka liver disease where tissue is replaced by fibrosis tissue
what is the flow of blood vs. bile @ the liver lobule?
hepatic portal v&a go TO the central canal (aka central vein) vs. bile flowing OUT from center towards the bile duct @ outer edge
what are kupffer cells?
they lie within the hepatic sinusoids (that carry blood towards center) and are macrophase–immuno
what are ito cells? and how does it related to vision? (think retina) where are the ito cells located?
pericyte that is responsible for liver fibrosis @ liver damage.
- hold fat droplets that contain Vit A for retinal ester
- located @ the space of disse
where/what is the hepatic cannaliculi?
passage way where bile (produced by hepatocytes @ liver) goes through to drain to hepatic ducts–eventually gallbladder for storage
when do gallstones form?
too much bilirubin & cholesterol (lipids) OR not enough bile salts
what is the path of bile after it’s made @ liver & stored in the gallbladder
hepatic duct–> common hepatic duct –> (cystic duct if from gallbladder)–> pancreatic duct –> ampulla of vater & spincter of oddi–> duodenum of small I
what is gout?
accumulation of uric acid crystals form urea break down @ joints of the foot
- painful
- overload of uric acid @ blood
- ppl who eat organs
what layer covering is the gallbladder/
retro-peritoneal
-along with kidneys, pancrease, sigmoid colon, bladder
what happens with pancreatic cancer? what happens if you find jaudice in the eye?
extra-heptaic obstruction of bile will cause jaundice when you have cancer
- JAUNDICE= too much bilirubin in blood
- can cause portal and inf. vena cava obstruction
what is produced by pancreatic islet cells? (cells of langerhan!)
- alpha= glucagon–> raises blood glucose= increase blood sugar
- beta= insulin** and amylin—> inhibits glucagon || remove excess glucose from blood || decrease use of fat as E
- delta= somatostatin–decrease stomach acid production
