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Medicine > Case 2 > Flashcards

Case 2 Flashcards

1
Q

What is the peritoneum?

A

Flattened mesothelial cells, with an immune function, over a connective base. This lines the abdominal cavity.

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2
Q

What two structures is the peritoneal cavity between?

A

The Parietal and Visceral peritoneum.

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3
Q

An alternative name for peritoneal cavity is…

*What fluid is here?

A

Potential Space

*Serous Fluid

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4
Q

Give two compartments of the peritoneal cavity

A

The Greater Sac and the Lesser Sac

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5
Q

Describe where the Greater Sac is

A

Superiorly - behind liver
Inferiorly - between layers of Great Omentum
Infront of Transverse Mesocolon

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6
Q

Describe where the Lesser Sac is

A

The space behind the stomach (structures can travel here)

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7
Q

How are the Greater and Lesser Sac connected?

A

Through the Epiploic Foramen (can put finger in here)

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8
Q

What is the outside layer of Peritoneum called?

A

Parietal Peritoneum

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9
Q

When the Parietal Peritoneum dips inwards, folds ( = two layers) and covers an organ, it becomes…

A

Visceral Peritoneum

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10
Q

What is the Greater Omentum?

A

4 layers of Visceral Peritoneum

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11
Q

Give the 9 quadrant model of the abdominal cavity

A

Right Hypochondriac, Epigastric, Left Hypochondriac
Right Lumbar (flank), Umbilical, Left Lumbar (flank)
Right Iliac Fossa, Hypogastric, Left Iliac Fossa

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12
Q

Give the 4 quadrant model of the abdominal cavity

A

Right Upper Quadrant (UQ), Left UQ

Right Lower Quadrant (LQ), Left LQ

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13
Q

What is the Lesser Omentum?

A

2 layers of Visceral Peritoneum

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14
Q

Describe the location of the Greater Omentum

A

Starts from greater curvature of stomach, descends, covers small intestine (like an apron), folds back, and attaches to anterior surface of transverse colon.

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15
Q

Describe the location of the Lesser Omentum

A

Starts from liver and joins the lesser curvature of stomach and proximal duodenum.

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16
Q

What is peritonitis?

A

When fluid builds up in the potential space, leading to infection.

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17
Q

What is the abdominal cavity in-between?

A

Ribcage and pelvis

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18
Q

Women have a greater risk of peritonitis. Why?

A

Peritoneal cavity is not closed because of uterine tubes, uterus and vagina. However, it is rare to develop this disease.

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19
Q

Organs outside the/posterior to the peritoneum are called…

A

Retroperitoneal

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20
Q

Organs inside the peritoneum are called…

A

Intraperitoneal

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21
Q

What are Peritoneal reflections?

A

Folds in peritoneum which attach organs to the abdominal walls or organs to other organs.

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22
Q

Name all the ligaments in the body

A 
Stomach-Diaphragm = Gastrophrenic
Stomach-Intestine = Gastrocolic
Stomach-Spleen = Gastrosplenic
This joins the greater curvature of stomach to spleen. Has short gastric vessels and left gastro-epiploic vessels.
Spleen-Kidney = Splenorenal
Stomach = gastro
Diaphragm = phrenic
Intestine = colic
Kidney = renal
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23
Q

What are the peritoneum folds that attach organs to other organs?

A

Ligaments

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24
Q

Describe the peritoneum fold that joins the Liver to the abdominal wall

A

Falciform
Triangular ligament - posterior layer of left lobe of liver to diaphragm
-anterior layer continuous with left layer of falciform

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25
Q

Describe the peritoneum fold that joins the small intestine to the abdominal wall

A

Mesentery of SI

Two layers of visceral peritoneum wrap around SI and attach to wall.

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26
Q

What is the small bowel mesentery?

A

Broad, fan shaped fold of peritoneum connecting jejunum and ileum to posterior abdominal wall.

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27
Q

What is the Transverse Mesocolon?

A

Transverse colon of Left Intestine to wall
-Visceral layer from greater omentum
-Meets Transverse colon and splits
-Wraps around Transverse colon
-Reattaches on other side of Transverse colon
=TM

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28
Q

What does the Transverse Mesocolon separate the abdominal cavity into?

A

Supracolic and infracolic compartment

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29
Q

Why is it important that the greater momentum can migrate?

A

If the appendix bursts, the GO can migrate and wrap around it. This stops infection as appendix has faeces in it.
‘Known as ‘policemen of the abdomen’

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30
Q

Where is the supra colic compartment and what does it contain?

A

Lies above the transverse mesocolon, between the diaphragm and the transverse colon.
It contains three major organs: the stomach, the liver and the spleen
Has subphrenic recess - space inferior to diaphragm, which is divided into the left and right recesses by falciform.
Has hepatorenal recess (of Morisson) - space between liver and kidney, lowest in supine position.

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31
Q

Where is the infra colic compartment?

A

Below the transverse mesocolon and transverse colon.

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32
Q

Where are gutters found?

A

Supracolic and infracolic compartment

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33
Q

What are gutters?

A

Deep impressions in posterior abdominal region, allow communication between compartments

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34
Q

What is an important gutter and why?

A

Right lateral paracholic gutter

No ligaments here, so infection can travel up.

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35
Q

Where are the paracolic gutters found?

A

Outside intestines

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36
Q

Where are the infracolic gutters found?

A

Within the intestines

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37
Q

What divides the gutters into left and right?

A

Mesentery of Small Intestine

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38
Q

What are three types of gutters?

A

Lateral
Medial
Infracolic

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39
Q

What are medial gutters limited by?

A

Transverse mesocolon

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40
Q

What is the left parabolic space limited by?

A

Phrenicolic ligament

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41
Q

How can infection spread in the peritoneal cavity?

A
  • Fluid builds up in spaces
  • Create space between reflections
  • Spaces are continuous
  • Infection spreads
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42
Q

What is Paracentesis?

A

Surgical drainage of cavity.

A needle and cannula through the anterolateral abdominal wall to drain fluid.

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43
Q

What does extraperitoneal mean?

A

Position of abdomen and pelvis not within the peritoneum

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44
Q

What does sub peritoneal mean?

A

Lies inferior to peritoneum

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45
Q

Describe the development of the gut tube into the duodenum

A

-Gut tube starts off as simple tube
-Three parts; 1st part of tube/ foregut rotates and makes stomach, liver and 1st part of duodenum.
-midgut/middle part of gut tube makes jejunum, ileum, ascending colon and medial 2/3’s of transverse colon.
-hindgut/last part of gut tube makes descending colon, sigmoid colon and rectum.
Mesogastrium is double layered peritoneum attaches foregut to anterior and posterior abdominal walls.
Back - dorsal mesogastrium (greater curve of stomach, spleen grows here)
Front - ventral mesogastrium (lesser curve of stomach, liver grows here)

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46
Q

What organs are within the intraperitoneal compartment?

A

stomach, spleen, liver, bulb of the duodenum, jejunum, ileum, transverse colon, and sigmoid colon

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47
Q

Describe the features of a kidney and what they do (not micro anatomical)

A
  • Triangles on outer edge of kidney are Medullary pyramids
  • Minor calyces: what Medullary pyramid branches off
  • Renal papilla: in between medullary pyramid and minor calyx, urine drains into ureter here
  • Major calyces: what Minor calyces branch off
  • Renal cortex: outside, on top of Medullary pyramid
  • Renal column: in between Medullary pyramids
  • Renal artery: drain into Major calyces of renal sinus, joins to abdominal aorta, waste comes in here
  • Renal vein: drains into Major calyces of renal sinus, connected to IVC back to heart
  • Arcuate artery: boundary between medulla and cortex
  • Ureter: drains out of renal pelvis into bladder
  • Renal sinus: spaces between Major and Minor calyces.
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48
Q

What is the kidney’s role?

A

To filter blood and remove waste.

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49
Q

Describe the branching of the renal artery into the kidney

A

Renal artery - interlober artery - interlobular artery

Kidney is divided into lobes which become lobules

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50
Q

What does the glomerulus do?

A

Filters blood

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51
Q

What does the afferent arteriole do?

A

Takes blood to glomerulus

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52
Q

What does the efferent arteriole do?

A

Takes blood away from the glomerulus

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53
Q

Where are glomeruli found?

A

Cortex of kidney

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54
Q

Where are the loops of henle found?

A

Medulla of kidney

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55
Q

What are vasa recta?

A

Long, straight vessels which are looped and match up with loops of henle in medulla.
Have red blood cells

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56
Q

What does the arcuate vein do?

A

Above arcuate artery, joins to Renal Vein

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57
Q

Describe what happens to blood as it enters kidney

A
  • Blood from heart in aorta
  • Blood enters kidney through Renal Artery
  • Interlobar arteries
  • Arcuate arteries
  • Interlobular arteries
  • Afferent arteriole
  • Blood supplied to nephron
  • Blood filtered through glomerulus
  • Efferent arteriole
  • Peritubular plexus, associated with PCT (Proximal Convoluted Tubule) and DCT (Distal Convoluted Tubule)
  • Blood into Vasa Recta as venous drainage
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58
Q

The nephron is a simple structure where urine is drained into. True/False?

A

False

Urine does drain here, but nephron has many different parts, all with own roles.

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59
Q

Where does urine collect in the medullary?

A

Cortical collecting duct

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60
Q

What is the Bowman’s Capsule?

A

Blind end of the nephron

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61
Q

What is the role of the Mesangium?

A

Support for the glomerulus

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62
Q

Describe the features of Mesangium

A
  • Fenestrated endothelium: allows filtration into urinary space
  • Basement membrane: secreted by endothelium and podocytes
  • Podocyte: interlocking foot like processes
  • Lamina rare interna: layer over basement membrane
  • Lamina densa: in between rara externally and rare international
  • Lamina rara externa: outermost layer
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63
Q

Describe the structure of the glomerulus

A
  • Surrounded by Bowman’s Capsule
  • Made of capillaries
  • Urinary space allows filtration
  • Afferent and efferent arteriole connected to it
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64
Q

Where is the cortical labyrinth?

A

Adjacent to glomeruli

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65
Q

What structures are in the cortical labyrinth?

A
  • Efferent arteriole
  • Afferent arteriole
  • Juxtaglomerular cells (secrete renin which controls BP)
  • Mesangial cells
  • Lacis cells (type of Mesangial cells, support and involved in phagocytosis)
  • Proximal Convoluted Tubules (thick walls to control reabsorption)
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66
Q

What structures are in the medulla?

A
  • Vasa Recta
  • Collecting duct
  • Loops of Henle
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67
Q

Describe the features of Loops of Henle

A
  • Different sized walls
  • All packed together
  • Have supporting cells
  • Simple
  • Lumen surrounded by walls
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68
Q

Describe the lower urinary tract

A

Renal pelvis - Ureter - Bladder - Urethra

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69
Q

What types of muscle are there in the urinary tract?

A
  • Submucosa
  • Urothelium lining
  • Right spiral muscle
  • Loose muscle spiral
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70
Q

How does urine move from the ureter to the bladder?

A

-Muscular walls contract = Peristalsis

= urine forced down ureter to bladder

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71
Q

Describe the structure of the lumen

A
  • Stellate lumen (rings of muscle)
  • Smooth muscle around stellate lumen
  • Urothelium on outside
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72
Q

Describe the structure of the bladder

A
  • 3 layers of smooth muscle
  • Submucosal layer below epithelium (made of collagen)
  • Urothelium layer which expands when bladder is full
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73
Q

Describe the structure of urothelium of bladder

A
  • Bottom layer is cuboidal basal cells
  • Intermediate layer is polygonal cells
  • Top layer is ‘umbrella’, dome shaped, binucleate and protect from urine
  • Distended flattened layer at top, full of urine. Urine is unable to get out
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74
Q

The urothelium of the bladder is in a fixed position. True/False?

A

False

It changes structure in different states

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75
Q

What are the three phases of kidney development in the embryo?

A
  • Pronephros
  • Mesonephros
  • Metanephros
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76
Q

What happens during pronephros?

A
  • Kidney near head of embryo

- Transient (non-functional) in humans

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77
Q

What happens during metanephros?

A

-Weeks 4-12 (transient)
-Limited functionality
Week 5: Intermediate mesoderm formed (will become nephrons)
Mesonephric duct formed
Ureteric bud off mesonephric duct
Week 6: Branching
Week 7: Metanephric mass formed
Major Calyx forms
Further branching
Week 8: Major and Minor Calyx fully formed
Lobules formed
Ureter formed
Renal Pelvis formed

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78
Q

What happens during mesonephros?

A

Definitive human kidney formed

Functional by week 12

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79
Q

Describe the migration of a normal kidney

A

Kidneys move up posterior wall into suprarenal glands (look like hats)
Week 6: Hilum started facing anteriorly (front), as kidneys go up, kidneys rotate and hilum faces medially.
Week 7-9: Transient and renal arteries branch from aorta. Kidneys have fully grown into glands

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80
Q

What are the possible development defects in kidneys?

A

Renal agenesis: 1 or both kidneys fail to develop or migrate. If both, then it is fatal.
Unilateral renal hypoplasia: kidney not fully developed
Supernumerary kidney: extra kidney

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81
Q

What are the possible malignation defects in kidneys?

A

Renal Ectopia: kidney doesn’t migrate and remains in pelvis
Abnormal Rotation: hilum is still ventral
Horseshoe kidney: both kidneys fuse at midline
Supernumary (multiple) renal vessels: transient renal vessels don’t disappear, trapping ureter. Hydronephrosis can happen, this is when urine builds up.

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82
Q

What are the three fluid compartments within the body? (Give their percentage of fluid)

A

-Intracellular (in cells, 40% of Body Weight)
-Extracellular (outside cells) splits into
Interstitial (outside cells with plasma, 15% of BW) and Plasma (5% of BW)

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83
Q

What determines the size of a fluid compartment?

A

No. of osmotically active particles as water follows these.

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84
Q

What happens to the volume of a compartment if there is an increase in osmotically active particles.

A

Volume increases, because water will move along gradient from other compartments. (Vice versa if particles are lost).

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85
Q

Water can freely move across compartments. True/False?

A

True

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86
Q

The osmolality of each compartment is 140mOsm/kg. True/False?

A

False

It is actually 280mOsm/kg

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87
Q

Which specific particles control the intracellular fluid compartment?

A

K+, HCO3-, Cl-

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88
Q

How does the intracellular compartment react to volume changes?

A

-Volume goes down
-Membrane can actively take up particles
= increase in fluid
-Na-K pump helps in this regulation
(Vice versa if fluid is gained - particles are removed from compartment)

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89
Q

Which particles specifically control the size of the Interstitial and Plasma?

A

Na+, HCO3- and Cl-

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90
Q

Like the intracellular compartment, the Extracellular compartments (Interstitial and Plasma) can also self regulate their volume. True/False?

A

False
Their volume is determined by Starling forces = proteins are unable the plasma space, so are trapped there.
Proteins are freely permeable across the vascular wall, so if they leave the plasma and enter the Interstitial then the normal state is disturbed.

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91
Q

What is Colloid Osmotic pressure?

A

No. of osmotically active particles and drives water back into capillaries

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92
Q

What is hydrostatic pressure?

A

Pushes fluid out of capillaries into interstitium

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93
Q

What happens if COP and HP are balanced?

A

No net gain or loss of fluid

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94
Q

What happens to Starling forces if protein is lost?

A 
Decreased COP
Balance disrupted
HP is able to decrease more before COP can act
= Loss of fluid
Blood volume decreases
Interstitium increases in volume
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95
Q

Why is fluid balance important in blood?

A

-Control BP
Lose fluid = BP drops
Gain fluid = BP increases
-Enough blood for organ perfusion

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96
Q

Why is fluid balance important in the interstitium?

A

-Stop oedemas forming

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97
Q

Why is fluid balance important in cells?

A

-Protect cells from shrinking or swelling
Water in brain - increase in inter cranial pressure - blood vessels squeeze down on - irreversible cell death = brain pushes down on spinal cord = brainstem compressed = death
Shrinking tears blood vessels and neurones = coma/death

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98
Q

Why is fluid balance important in plasma?

A

Plasma volume decreases = BP increases = stroke

Plasma volume increases = anoxia (absence of oxygen)

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99
Q

What does Starlings suggest?

A

Starlings hypothesis states that the fluid movement due to filtration across the wall of a capillary is dependent on the balance between the hydrostatic pressure gradient and the oncotic pressure gradient across the capillary.

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100
Q

Why is it important to take fluid in slowly?

A

Rapid changes in water balance can be fatal

101
Q

How does the kidney help maintain fluid balance?

A
  • Controls plasma volume through amount of Na+ in body
  • Stretch receptors on vasculature that detect plasma volume as vascular ‘stretch’
  • Volume receptors detect plasma volume
  • Osmoreceptors detect osmolality
102
Q

What is isotonic/isosmotic dehydration?

A

Amount of Na lost is equal to water lost (H2O=NaCl)

103
Q

How does isotonic/isosmotic dehydration happen?

A

Internal: ileus, ascites, pleural effusion (fluid lost to lungs)
External: vomiting, diarrhoea, haemorrhage, burns
Mechanism:
-Fluid lost from plasma
-Starlings forces drive fluid from interstitial compartment
= Decrease in ECF volume but no change in ECF osmolality
= no change in ICF volume on osmolality

104
Q

How is isotonic/isosmotic dehydration treated?

A

Volume loss = isotonic NaCl solution

Blood loss = whole blood or plasma expander

105
Q

What is hyperosmotic dehydration?

A

When fluid lost from plasma has more NaCl than water

106
Q

Describe what happens during hyposmotic dehydration

A

-Fluid lost from plasma
-Plasma volume decreases = hyposmotic when compared to interstitial
-Osmotic gradient pushes water to interstitial = volume increases but osmolality decreases = hyposmotic compared to intracellular fluid
-Osmotic gradient pushes water to intracellular fluid
-volume increases but osmolality decreases
Overall:
decreased Extracellular volume and osmolality
increased intracellular volume and decreased intracellular osmolality

107
Q

What causes hyposmotic dehydration

A
  • Renal loss of NaCl because of adrenal insufficiency (Addison’s disease)
  • Diuretics
  • Vomiting
  • Heavy loss of hyposmotic sweat
108
Q

How is hyposmotic dehydration treated?

A

0.9% NaCl isotonic fluid replacement

109
Q

What is hyperosmotic dehydration?

A

When the fluid lost is more H20 than NaCl

110
Q

Describe what happens during hyperosmotic Dehydration?

A

-Fluid lost
-Plasma volume decreases and more hyperosmotic that interstitial
-Starlings Forces and osmotic gradient push water from interstitial compartment = Interstitial volume decreases but osmolality increases
-Decrease in Extracellular compartment volume and increase in osmolality
-Extracellular compartment is more hyperosmotic that Intracellular compartment
-Osmotic gradient pushes fluid from ICF
= ICF volume decreases but osmolality increases
Overall, ECF and ICF volume decreases
ECF and ICF osmolality increases

111
Q

What causes hyperosmotic dehydration?

A 
Fever
Diabetes insipidus (increase in urine and thirst)
Diabetes mellitus
Excess loss of skin/breath
Decreased intake of water
Decreased ADH secretion
Stroke
Diarrhoea
112
Q

How is hyperosmotic dehydration treated?

A

Slow water replacement (water that has 10% dextrose)

113
Q

Why is it dangerous if children lose a lot of fluid?

A

Their fluid proportions are different, so losing a lot of fluid can be fatal - so they should always be treated first.

114
Q

Kidneys get the most blood in the body as they have to filter it. Describe how this blood is distributed in the kidneys.

A

93% of blood goes to the Cortex
7% goes to Medulla
1% goes to Papilla

115
Q

What types of nephrons are there?

A
  • Superficial
  • Mid-cortical
  • Juxtamedullary
116
Q

What are superficial nephrons?

A
  • Close to surface
  • All in cortex
  • Proximal tubule in cortex
  • Short loop of Henle
117
Q

What are mid-cortical nephrons?

A
  • Glomerulus in middle of cortex
  • Loop of Henle descends into medulla
  • Mainly in cortex (blood supply)
118
Q

What a juxtamedullary nephrons?

A
  • Brings blood to medulla
  • Glomerulus close to cortical border (between cortex and medulla)
  • Long loops of Henle
  • Blood from Renal Artery
119
Q

Why does only 7% of blood go to the Medulla?

A

Urine is produced here

120
Q

Describe the process of blood flow in the superficial and mid-cortical nephrons

A
  • Renal blood in left and right Renal artery
  • Artery branches into segmental, interlobar, arcuate and interlobular arteries
  • 1 arteriole to 1 nephron
  • Covers glomerulus as network of capillaries
  • Join together to form efferent arteriole
  • Divide to form peritubular capillaries surrounding nephrons
  • Peritubular venue, interlobar vein and renal vein leave
121
Q

Describe the process of blood flow in the juxtamedullary nephrons

A
  • Afferent arteriole formed
  • Goes to medulla as vasa recta vessels
  • Divide to become peritubular capillaries
  • Surround medullary segments of nephrons
  • Peritubular venue, interlobar and renal vein leave kidney
122
Q

How much CO goes to the kidney?

A

25%

123
Q

What is happening in the cortex of the kidney?

A
  • Proximal tubules here are the main site of reabsorption of solutes and water
  • Waste products and drugs are added to the filtrate
  • A high blood supply is needed
124
Q

What is happening in the medulla of the kidney?

A
  • Urine is made here
  • Medulla generates a hyperosmotic interstitial
  • Low blood flow means it’s not washed out
  • The medullary blood supply is in a loop, a there can be an exchange of solutes
125
Q

What is the importance of vascular resistance?

A

It maintains filtration pressure across the length of the capillary bed
This maintains renal blood flow and GFR

126
Q

Where are the sites of vascular resistance in the kidneys?

A

Afferent and efferent arterioles

127
Q

Hydrostatic pressure drops as you go along the glomerulus and systemic capillaries. True/False?

A

False

HP drops in systemic capillaries, but remains constant in glomerulus (this drives filtration)

128
Q

How do Afferent arterioles control vascular resistance?

A
  • Constrict = Increase resistance = Decrease renal blood flow, filtration pressure (FP) and GFR
  • Dilate = Decrease resistance = Increase RBF, FP and GFR
129
Q

How do Efferent arterioles control vascular resistance?

A
  • Constrict = decrease in RBF, increase I. FP and GFR

- Dilate = increase in RBF, decrease in FP and GFR

130
Q

How is Renal Blood Flow measured?

A

Clearance of PAH

In a clinical setting, measure using contrast enhanced ultrasound

131
Q

Is renal blood flow affected by systemic pressure?

A

No
If Systemic pressure increases, then BP will increase and blood flow in systemic circulation will increase
However, RBF stays the same
RBF is independent of systemic pressure

132
Q

Describe the structure of the glomerular apparatus that helps it filter

A

Distal tubule is folded back on itself

So when blood flow increases, more water and small molecules filter out.

133
Q

What range of mercury does the kidney auto regulate in?

A

80-180 mml

134
Q

What would happen if the kidney couldn’t auto regulate?

A

Would depend on systemic BP and blood flow

135
Q

What is the Myogenic Reflex?

A 
Used to regulate renal BP e.g.
-Systemic BP increases
-Renal Blood flow increases
-Afferent arteriole stretches (Ca channels open up = influx of Ca+)
-Smooth muscle contraction 
-Increase in resistance
-Renal blood flow back to normal
=GFR stabilised
136
Q

What is the Tubular Glomerular feedback?

A
  • Systemic BP increases
  • Increase in renal blood flow
  • Increase in filtration pressure
  • Increased amount of fluid and molecules filtered per unit of time
  • more NaCl filtered (sensed by Macula Densa cells in juxtaglomerular nephrons)
  • NaCl transported to distal tube (more NaCl = more transport)
137
Q

What is adenosine?

A

Neurotransmitter involved in controlling RBF and GFR

138
Q

How does Adenosine work?

A

-Adenosine released form Macula Densa cells
-Diffuses to adjacent afferent arteriole
-Acts on A1 receptors
-Ca enters
-Smooth muscle contraction
= afferent arteriole increases
= RBF and GFR stabilised

139
Q

What protective mechanism is put in place when a haemorrhage (bleeding) occurs?

A

Blood loss = Systemic blood volume and BP goes down = Perfusion of organs decreased

Blood needs to be diverted from the kidneys:

  • Decrease in BP stimulates renal sympathetic nerves to release NEP and adrenal gland to release EP
  • Angiotension II generated from rise in plasma renin concentration = constriction of renal arteries
140
Q

What is the effect of a high concentration of a vasoconstrictor on afferent arterioles?

A
  • Decrease of renal blood flow
  • Decrease in GFR = Blood stays in systemic circulation
  • if this happens for too long, then the kidney will die
141
Q

What is the effect of a low concentration of a vasoconstrictor on efferent arterioles?

A
  • Decrease in diameter
  • Increase in resistance
  • Decrease in RBF
  • GFR drops slightly
142
Q

What hormone is released when the kidney is about to die and how does it work?

A

Decrease in RBF and O2 stimulates medulla to release Prostoglandin
This is a vasodilator - increases RBF, allows perfusion of kidney and stops kidney from dying.

143
Q

What inhibits Prostoglandin?

A

NSAIDS

Dangerous to give to women (already have low BP)

144
Q

What stimulates normal NO production?

A
  • Stress (force on blood vessel)
  • Histamine (inflammatory)
  • Brakykinin ( inflammatory)
  • ATP
145
Q

What does NO do?

A

Causes Vasodilation and Renal Peripheration

146
Q

What is the danger of abnormal production of NO in Diabetes Mellitus and Hypertension?

A

Too much dilation = damage to blood vessels/vascular damage

147
Q

Where is the retovesical pouch in males?

A

Between bladder and rectum

148
Q

Where is the vesicouterine pouch in females?

A

Between bladder and uterus

149
Q

Describe how renal hypertension can happen from a false signal?

A

-Renal artery is narrowed
-Decrease in RBF
-Increase in Angiotensin II
=Peripheral resistance and aldosterone induced Na reabsorption (=increase in blood volume)
=Hypertension

150
Q

What is the volume of distribution?

A

The concentration of the drug in the plasma

concentration of drug when initially taken

151
Q

What affects the volume of distribution?

A
  • How permeable the drug is across the membrane
  • Whether it binds to compartments (like proteins)
  • pH partition (bases accumulate in acidic compartments)
152
Q

If a drug has a very high volume of distribution, what does that suggest?

A

It is lipid soluble and has been stored in fatty/adipose tissue.

153
Q

How is the volume of distribution calculated?

A

Dose (D)/ drug plasma concentration (Co)

154
Q

How can the initial drug plasma concentration be found from a graph?

A

-Point the plots of the curve
-Extrapolate to when time = 0
= initial plasma concentration of blood

155
Q

What is clearance?

A
  • Not excretion

- Clearing of drug from plasma per unit of time (e.g. per second)

156
Q

What affects clearance (Cl)?

A

Metabolism

157
Q

What is a half life (t1/2)?

A

Time then for the concentration of a drug to half

158
Q

What affects the half life of a drug?

A

Faster metabolism = short half life = not in plasma long

159
Q

What is used to work out the dosage of a drug?

A

The half life

160
Q

How is the half life of a drug calculated?

A

Using graph:
-Choose a point on the concentration side
-See how long it takes for that concentration to half
OR
Use t1/2 = 0.693/Kel (elimination rate constant)

161
Q

How is clearance calculated?

A

Kel x Volume of Distribution

Kel = 0.693/ t1/2

162
Q

Draw and describe a graph for a drug that has 1st order kinetics

A
  • Descending curve, touches line
  • Concentration on side, time at bottom
  • ‘At first, the drug is cleared from the plasma at a rate proportional to the plasma level. However, as more drug is given, more drug is cleared out. This is an example of a prescribed drug.
163
Q

Draw and describe a graph for a drug that has 0 order kinetics

A
  • Straight line descending
  • Plasma concentration on side, time at bottom
  • Drug is cleared at a constant rate (independent of plasma)
  • Drugs cleared through enzymes, once these are saturated, this gives a constant rate of clearance
164
Q

What is a steady state (Css)?

A

The point where the amount of drug given exactly replaces the amount lost

165
Q

What is the therapeutic range?

A

The concentration of drug at which the patient will experience the desired clinical effect with a minimum of undesirable or adverse reactions.

166
Q

What affects the therapeutic range?

A

Size of range: determined by the toxicity of the drug.

167
Q

How can the drug plasma concentration be kept within the therapeutic range?

A

-Give small, frequent doses ( too much = toxic, too little = doesn’t reach range)

168
Q

How is steady state calculated?

A

Bioavailability x Dose / Interval dosing x Clearance

169
Q

What is the loading dose?

A

Amount of drug initially given

170
Q

How is the loading dose calculated?

A

Volume of distribution x desired steady state

Vd x Css

171
Q

What is the maintenance dose?

A

Frequent doses given after the initial dose to maintain the therapeutic range
Used to replace the drug lost through metabolism and excretion

172
Q

Describe how a steady state is reached through repetitive dosing

A

1st does - 50% of steady state reached after 1st half life
2nd dose - 75% of Css (25% from 1st, 50% from 2nd)
3rd dose - 87.5% of Css (12.5% + 25% + 50%)
4th dose - 93.75% of Css
5th dose - 97% of Css

173
Q

What is a ‘short half’ drug?

A
  • Stays in body for a short amount of time
  • Effects wear off quickly
  • Need to take more of to prolong affects
174
Q

What is a ‘long half life’ drug?

A
  • Remains in body for longer

- Take less of

175
Q

How many doses is usually needed to reach a steady state?

A

5

176
Q

How much of a drug should you give if the therapeutic range needs to be met quickly?

A

A high amount =

An increased loading dose will hit the therapeutic range and the benefits of that drug will happen quickly

177
Q

What are the features of the glomerulus?

A

Endothelial cell layer
Podocytes
Basement membrane

178
Q

Describe the features of the endothelial cell layer and the functions of each feature

A
  • Fenestrated endothelium (space between endothelial cell), looks like sieve
  • permeable due to pores (fewer pores = less GFR)
  • Movement of water and substances
  • Barrier to large proteins
179
Q

Describe the features of the basement membrane and the functions of each feature

A
  • Made up of collagen fibril mesh
  • Intertwined fibres
  • Fusion of endothelial layer and podocytes
  • Has collagen, laminin and proteoglycans
  • Filters based on charge and size (this is lost in glomerular disease)
180
Q

Describe the features of the Podocytes and the functions of each feature

A
  • Filtration slits (from extensions crossing over) are 7 x 14nm
  • Cover basement membrane facing Bowman’s capsule
  • Large cell body
  • Extensions wrap around glomerulus capillaries
  • Filtration slits make sure large molecules don’t get through
181
Q

COP changes in systemic circulation. True/False?

A

False

Remains constant

182
Q

What causes COP to be altered?

A

Hypertension and proteinuria

183
Q

Describe the pressure changes in the systemic capillaries

A

1st half of capillary: HP > COP
2nd half of capillary : HP < COP
Overall, fluid exchange but no net movement
= no net filtration of fluid from blood into interstitium

184
Q

Describe the pressure changes in glomerular capillaries (afferent and efferent)

A

*Small drop in pressure from afferent to efferent
Constant positive filtration pressure drives fluid and small molecules from blood across glomerular barrier into Bowman’s capsule.
Called ‘primary filtrate’

185
Q

What happens if the HP = COP?

A

No/ negligable filtration

186
Q

In the glomerular capillaries, it is always HP > COP. True/False?

A

True

The constant net fluid movement means there is a gradual rise in COP along capillary.

187
Q

How is GFR measured?

A

Measure a substance that is freely filtered at the glomerulus. Cannot be

  • reabsorbed/secreted by nephron
  • metabolised/produced by kidney
  • alter GFR
188
Q

Which substances are used to measure GFR?

A

Creatinine or Inulin

The amount filtered = amount secreted

189
Q

How is GFR calculated? (equation)

A

Urine Concentration (U) x Urine Flow / Plasma Concentration
OR
Uinulin x V (rate of urine concentration) = Pinulin (plasma concentration) x GFR

190
Q

What is GFR?

A

Clearance of solute from blood that is freely filtered (not secreted/reabsorbed) per ml of blood per min

191
Q

What is the value of Creatinine affected by?

A

Muscle bulk

Hydration state

192
Q

What is Creatinine the end product of?

A

Creatine Phosphate breaking down

193
Q

If GFR drops by 1/2, what happens to the amount of Creatinine in the plasma?

A

x2
(GFR drops by 3/4, Creatinine x 4
GFR drops by 7/8, Creatinine x 8)

194
Q

In steady state, the Creatinine plasma concentration is matched by its production/loss. True/False?

A

True

195
Q

What affects GFR?

A
  • Vascular Resistance
  • Renal Blood Flow
  • Changes in surface area (Kf)
  • Changes in HP
  • Changes in COP
196
Q

How does vascular resistance affect GFR?

A

Afferent arterioles:
-Constrict = Decrease in RBF, FP and GFR
-Dilate = Increase in RBF, FP and GFR
Efferent arterioles:
-Constrict = Decrease in RBF, increase in FP and GFR
-Dilate = Increase in BRF, decrease in FP and GFR

197
Q

How does renal blood flow affect GFR?

A 
Vasoconstriction: (need ANP to dilate)
-High BP
-Blood vessels damaged
-Glomerulus damaged
-Scar tissue thickens barrier = decrease in GFR
Low BP:
-Hypoxic cell death (in medulla)
-Death of nephrons
-Decrease in functional glomeruli = decrease in GFR
198
Q

How does changes in surface area of the glomerulus affect GFR?

A

Caused by disease (atherosclerosis, diabetic nephropathy, nephrotic syndrome, nephritic syndrome, infection)
Thickening of glomerular barrier (immune response to disease) = barrier becomes leaky to protein
= decrease in GFR

199
Q

How does changes in HP affect GFR?

A
  1. Increase pressure in capillaries = hypertension and volume tension = increase in GFR
  2. Renal stones - kinks in ureter = blockage, fluid stuck in nephron = infection = decrease in GFR
200
Q

How does changes in COP affect GFR?

A

Capillary:
Volume increases and protein decreases = decrease in COP across glomerulus = increase in GFR
Bowman’s Capsule:
Protein decreases = increase in COP = increase in GFR

201
Q

What is net HP?

A

Pressure in capillaries - Pressure in Bowman’s space

202
Q

What happens as proteinuria progresses?

A
  • GFR decreases
  • Decrease in circulation
  • BP drops
  • GFR auto regulation drops
  • Afferent arteriole vasoconstriction
203
Q

What is filtrate and where is it produced?

A

Initially, the concentration of the solute from glomerulus

204
Q

What happens in the nephron?

A

Urine from filtrate comes here. Water and solute modified here.

205
Q

Label a tubule

A

Glomerulus

Nephron

206
Q

Describe what happens to blood at the glomerulus

A
  1. Left untouched, so the amount filtered = amount secreted. (Freely filtered)
  2. Filtered, then reabsorbed. Amount secreted < amount filtered. (glucose, amino acids, Na+)
  3. Filtered, then secreted. Amount secreted > amount filtered (drugs, metabolic end products).

All together = amount of urine

207
Q

How much blood is filtered per day?

A

180L, 125ml/min of water

208
Q

What is PAH and why is it important?

A

Para-amino-hippurate

Tells us about the health of the kidney

209
Q

What happens to glucose at low concentrations?

A

All reabsorbed in proximal tubule

This is mediated bu transport proteins, SGLT2 (high capacity, low affinity) and SGLT1 (low capacity, low affinity)

210
Q

Normally, the amount of inulin filtered is…

A

proportional to Pinulin x GFR

211
Q

How do we use inulin to compare to the molecules?

A

Molecule in urine < inulin = reabsorbed
Molecule in urine > inulin = secreted
Molecule in urine = inulin is freely filtered

212
Q

Glucose that is normally filtered is not lost in the urine. True/False?

A

True

213
Q

What is the plasma threshold for glucose?

A

375mg/min
Initial amount of glucose in the urine is up to 12mM
This is 3x plasma glucose concentration, therefore the kidney does not control plasma glucose

214
Q

Why might someone have excess glucose in their body?

A

Diabetes or familial glycosuria (defect in SGLT2)

215
Q

How is phosphate handled in the kidney?

A

-10% of load/amount being filtered
-80% filtered in proximal tubule, 10% in distal tubule
-Transport proteins are NAPi2a and NAPi2c
-Tmax is0.1mM/min (if this is exceeded, then it will spill into the urine)
-Plasma threshold is 1.2mM in plasma phosphate (kidney does control plasma phosphate levels)
-PTH hormone can alter Tmax
Too much phosphate is dangerous

216
Q

How is PAH handled in the kidney?

A

-Freely filtered and secreted
Rate = PPAH x GFR + secretion rate
-Filtered in glomerulus
-Efficiently secreted by proximal tubule (mediated by anionic transport proteins)
-Tmax is 80mMg/min
-Plasma threshold > plasma PAH
-No PAH left in renal blood (clearance of PAH = renal plasma flow)

217
Q

Give the equation to calculate clearance of PAH

A

UPAH x V / PPAH

Urine concentration of PAH X Volume / Plasma concentration of PAH

218
Q

What is TMAX?

A

Time to Maximum Plasma Concentration/Maximum effect

219
Q

What happens at the proximal tubule?

A

Solute is reabsorbed = used to create osmotic gradient for water reabsorption. 70% water is reabsorbed.
This is the same is hydrated and dehydrated states.

220
Q

What happens at the Distal tubule connecting tubule?

A

Solute is reabsorbed = osmotic gradient drives water back into nephron
ADH controls the water reabsorption
4/5 % water is reabsorbed here

221
Q

What happens in the loops of Henle?

A 
Interaction of nephron segments
Hyperosmotic gradient around the tubule, so water is reabsorbed in the thin descending limb
No water reabsorbed in ascending limbs
20% of water reabsorbed
Independent of hydration state
222
Q

How are water and osmolytes exchanged in the nephron?

A

Medulla - loops of Henle from mid cortical and juxtaglomerullary nephron have long loops and descend into medulla towards the papilla
There is countercurrent flow of filtrate in nephron (limbs going up and down)
This allows interaction between adjacent nephron segments = exchange of water and osmolytes

223
Q

How is the hyperosmolar environment of the medulla made?

A

Blood to medulla is from juxtaglomerular efferent arterioles (this is 7 % of renal blood flow). Must stop osmotically active particles washing out to create hyperosmotic environment.
-Selective transport of water and salt in nephron segments
-Build up of NaCl and urea (40% of osmotically active particles in medulla)
= hyperosmolar environment of medulla
Overall, urea trapped in medulla = osmotic gradient

224
Q

What is one concern in a low protein diet?

A

Reduction in urea in medulla = reduction in ability to make a concentrated urine

225
Q

Describe the ‘single effect’

A

-Filtrate enters the thin descending limb
-This filtrate is the same as plasma (300mOsM) = isosmotic
-Water is lost here
Filtrate enters ascending thin limb
-NaCl lost in ascending limb = 100mOsmM (hyposmotic compared to plasma)

226
Q

What does ADH do to the collecting duct?

A

The collecting is impermeable to water unless ADH is present. ADH inserts water pores in the CD

227
Q

What happens in the thin descending limb?

A
  • NaCl and urea can’t leave/enter
  • Passes hyperosmotic interstitium = gradient across the tubule allows water to leave
  • 20% of water left = 300mOsmM to 1200mOsM
228
Q

What happens in the thin ascending limb?

A

-Water can’t leave
-Gradient between tubular fluid and interstitium (from trapped urea)
-NaCl leaves tubule lumen
-Increased NaCl in interstitium
=osmolality of interstitium increases
-Decrease in osmolality of tubular lumen
-water driven out of descending tube
-Passive NaCl reabsorption down gradient

229
Q

What happens in the thick ascending limb?

A

-Water can’t leave
-NaCl and urea leave through Na:K:2Cl co transporter on apical side of tubular cell
-Urea can be absorbed
-NaCl increases in interstitium
= increase in osmolality of interstitium and decrease in O of tubular lumen
-Fluid is 100mOsM
-No ADH = dilute urine
-Active NaCl reabsorption from interstitium

230
Q

Why is urea recycled?

A

To maintain the osmotic medulla

231
Q

What is urea?

A

Product of protein metabolism

A small molecule that is freely filtered in the nephron and cleared by the kidney

232
Q

Describe what happens to urea when it reaches the nephron

A

-Proximal tubule
-50% reabsorbed back into blood
-Goes to thin ascending limb
-50% filtered load added to filtrate
-Thick ascending limb
-30% reabsorbed
Collecting duct
-55% reabsorbed
=15% in urine

233
Q

What happens at the Collecting Duct?

A

This passes through the hyperosmotic interstitium of medulla.
If ADH is present = water is absorbed and a concentrated/high osmolality urine is produced.
If ADH is not present = no water reabsorbed and a dilute/low osmolality urine is produced.
This is dependent on state of hydration.

234
Q

What makes up the loop of Henle?

A

Descending thin limb

Thin and thick ascending limb

235
Q

How is a dilute urine made?

A

-Fluid is in the descending thin limb
-the hypertonic interstitium removes water
=dilute and hypotonic urine

236
Q

What happens at the vasa recta?

A
  • Blood flows from afferent to vein
  • Is permeable to water and solutes
  • Osmotic gradient drives water from descending to ascending vessel
  • Concentration gradient drives NaCl from ascending to descending vessel
  • Water removed from medulla
237
Q

What is diuresis?

A

Increased production of urine (dilute)

238
Q

How does diuresis happen?

A
  • No ADH
  • No water absorbed in CD
  • NaCl is absorbed
  • Reduction in osmolality of tubular fluid
  • Low osmolality urine
239
Q

What is anti-diuresis?

A

Decreased production of urine (concentrated)

240
Q

How does anti-diuresis happen?

A

-ADH from posterior pituitary
-Aquaporin water channels placed in CD
-Water and NaCl absorbed in CD
-Water absorption driven by osmotic gradient between tubular lumen and interstitium
=high osmolality urine

241
Q

How is Na handled in the proximal tubule?

A
  • Freely filtered in glomerulus (Rate = PNa x GFR)
  • 70% of filtered Na is reabsorbed in proximal tubule
  • Na/Cl co transport
  • Na/solute co transport
  • Passive NaCl absorption
  • Na/HCO3 co transport
242
Q

Describe the Na/solute co transport system

A
  • Na gradient established (high ECF, low IF)
  • Drives accumulation of solutes
  • Uptake of solutes linked to uptake of Na across membrane of proximal tubule cells
  • uses energy
  • 10% of Na reabsorption
243
Q

Which solutes and transporters are involved in the Na/solute co transport system?

A 
Na/glucose uses SGLT1, SGLT2, SGLT3
Na/phosphate uses NaPi
Na/amino acid uses EAAC-1
Na/bile uses ASBT
Na/monacarboxylate uses MCT1
244
Q

What is Fanconi Syndrome?

A

Damage to proximal tubule = solutes in urine

245
Q

Describe how the solutes for the Na/HCO3 co transport system are collected

A

Need: H+, HCO3 and CO2
Na/H+ brings H+ into tubular lumen
HCO3 freely filtered at glomerulus (amount = PHCO3 x GFR)
CO2 freely permeable to renal proximal tubule’s membrane

246
Q

Describe what happens in the Na/HCO3 co transport system

A
  1. HCO3 + H+ <> H2CO3 (Catalysed by carbonic anhydrase)
    2.H2CO3 <> CO2 + H20
    Reactions are reversed:
  2. CO2 + H20 <> H2CO3
  3. H2CO3 <> HCO3 + H+
    HCO3 leaves the cell via Na/HCO3 transporter of basolateral membrane
    Movement of Co2 and gain of Na from Na/H = Na and HCO3 from tubular lumen to proximal tubular lumen
    Na leaves via Na K-ATPase at basolateral membrane
    *40% of Na reabsorption
    *Consumes energy
    *in early proximal
247
Q

Describe the Na/Cl co transport system

A
  • Cl freely filtered by glomerulus
  • Cl absorbed in exchange for organic anion (lactate, oxalate, formate) through Cl/OA transporter
  • Cl leaves through second Cl/OA transporter
  • This allows metabolic waste to be removed
  • Uptake of Cl linked to uptake of Na
  • OA accumulates in cell via TCA/OA exchanger at basolateral membrane
  • 15% of Na reabsorption
  • consumes energy
  • in late proximal
248
Q

Name everything in SADPUCKER

A 
Suprarenal Glands
Aorta
Duodenum
Pancreas
Ureters
Colon
Kidneys
Eosophagus
Rectum

Medicine (11 decks)

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