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BMS 538 > Exam 3 > Flashcards

Exam 3 Flashcards

Renal and Cardio

1
Q

What are the three functions of the Renal System?

A
  1. Cleans the Blood
  2. Regulates many ECF Components
  3. Endocrine Tissue
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2
Q

How Does the kidney Clean the Blood?

A

It removes waste products through filtering and then reabsorbs what it wants. Undesirable components are expelled through the urine.

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3
Q

How does the renal system regulate ECF?

A

It receives 25% of cardiac output so it can regulate the levels of blood components especially ions (Na+, K+, and Ca2+) and acid base balance

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4
Q

How is the kidney an endocrine tissue?

A

It releases hormones important for regulating BP (renin) and rBC production (EPO and Erythropoietin)

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5
Q

How much cardiac out put does the kidney receive?

A

25%

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6
Q

where are the kidneys located?

A

Side of spinal column in the dorsal body cavity

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7
Q

In humans which kidney is more anterior?

A

Left Kidney/more cranial

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8
Q

What color and texture are the kidneys?

A

Red, Brown and smooth

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9
Q

How big are the kidneys in humans?

A

10-12 cm long

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10
Q

What supplies the kidney with blood?

A

Each kidney has a renal artery

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11
Q

What drains the kidney?

A

Each kidney has a renal vein

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12
Q

What does the ureter do?

A

Moves urine from each kidney by a peristalsic motion and gravity to bladder

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13
Q

Describe the bladder

A

Thin stretchy bag of muscle that stores urine

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14
Q

What does the urethra do?

A

Expels urine out of the body from the bladder.

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15
Q

What would we see in a sagittal section of the kidney?

A

Cortex(Dark), Medulla and Renal Pelvis(Pale)

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16
Q

Why is the cortex of the kidney darker?

A

More vasculature, different cell types

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17
Q

What explains the coloration difference between the cortex and medulla?

A

Different cells, more vasculature in the cortex

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18
Q

What color is the renal pelvis?

A

pale, creamy yellow

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19
Q

What is the renal pelvis?

A

An extension of the ureter that expands to fill out the hollow cavity of the kidney

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20
Q

What does the renal pelvis do?

A

collect urine that is formed and emerges from the innermost medulla

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21
Q

In what direction does the kidney work?

A

from the outside in

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22
Q

Where does blood enter the kidney?

A

blood enters cortex of the kidney from the renal artery

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23
Q

What happens to the blood in the cortex in general terms?

A

It gets filtered

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24
Q

What fluid emerges from the medulla?

A

Urine

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25
Q

What is the boundary called between the cortex and medulla?

A

Cortico-medullary boundary

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26
Q

What is the kidney composed of?

A

Hundreds of epithelial lined tube structures called nephrons

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27
Q

What is the functional unit of the kidney?

A

The nephron

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28
Q

Is there connective tissue in the kidney?

A

no

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29
Q

Where is the Macula Densa?

A

Cortex

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30
Q

What part of the kidney are distal tubules found?

A

Cortex

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31
Q

What part of the kidney do you find loop of Henle?

A

Medulla

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32
Q

Where do you find proximal tubule in the kidney?

A

Cortex

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33
Q

Where do you find collecting duct of the kidney?

A

Medulla and cortex

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34
Q

Where do you find bowmens capsule?

A

Cortex

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35
Q

Where do you find a connecting tubule?

A

Cortex

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36
Q

Where is the renal corpusle?

A

Cortex

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37
Q

What does the renal corpusule do?

A

filters the blood and generates filterate

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38
Q

What does the proximal tubule do?

A

Selective reabsorbtion

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39
Q

What does the proximal tubule reabsorb?

A

Na, K, glucose, amino acids , bicarbonate

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40
Q

Where does the epithelial type change?

A

at the loop of henle

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41
Q

What does the loop of henle do?

A

Reabsorb water and Sodium Chloride

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42
Q

What is another name for the thick ascending limb?

A

distal straight tubule

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43
Q

Where does the distal tubule run?

A

From the outer medulla to the cortex

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44
Q

What does the distal tubule do?

A

Selective reabsorption but not as powerful as the proximal tubule

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45
Q

What does the collecting duct do?

A

Fine tuning (secretion and reabsorption)

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46
Q

Which molecule reabsorbs Na+ at the luminal membrane of the early proximal tubule?

A

Na-glucose symporter

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47
Q

How is Na+ reabsorbed at the basolateral membrane of the early proximal tubule?

A

Via Active Transport

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48
Q

What molecule reabsorbs Na+ at the luminal membrane of the early proximal tubule?

A

the Na-Glucose symporter

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49
Q

Where does the Na-Glucose symporter reabsorb Na+ in the early proximal tubule?

A

At the luminal membrane

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50
Q

What is the number one job of the kidney?

A

To clean the blood

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51
Q

What is the second most important function of the kidney?

A

regulate many components of the extracellular fluid

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52
Q

What are the two parts of the renal corpusle?

A
  1. A bundle of capillaries (glomerulus)

2. Bowmans Capsule (surrounds glomerulus)

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53
Q

Where does the glomerulus receive blood from?

A

An Afferant Arteriole

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54
Q

Where does blood leave the glomerulus?

A

An Efferent Arteriole (E for Exit)

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55
Q

Where does the blood get filtered?

A

in the glomeruli

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56
Q

As the blood flows through the capillaries of the glomerulus is it under high or low pressure?

A

High because part of the fluid portion of the blood is squeezed through capillaries into bowmans capsule

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57
Q

How much of the fluid portion of the blood is squeezed into bowmens capsule during filtration?

A

20-25%

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58
Q

Where does the filterate go from bowmans capsule?

A

To the proximal tubule where selective reabsorbtion occurs

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59
Q

If a sodium ion wants to enter bowmans capsule from the glomerulus what does it have to do?

A

Cross the wall of the capillary and then the wall of bowmans capsule

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60
Q

What makes up the filteration barrier in the renal corpuscle?

A

Wall of the capillary in the glomerulus and the lining of bowmans capsule.

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61
Q

What can cross the filteration barrier of the renal corpuscle?

A

Anything super small : Ions (Na,K, Mg)
Anything with a neutral charge or no net charge
Example: glucose, Water, very small proteins

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62
Q

What cannot cross the filteration barrier of the renal corpuscle?

A

Cells (RBCs and WBCs)
antibodies (large blood borne molecules)
Most Protein

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63
Q

T/F The blood has lots of protein

A

True

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64
Q

Describe the path of the proximal Tubule in the kidney.

A
  1. Begins in the cortex and winds around
  2. Dives into the medulla and turns into the loop of henle
  3. goes down the descending limb
  4. makes a hairpin loop in the deep medulla
  5. Comes back out in the ascending limb
  6. Turns into the distal straight tubule
  7. distal straight tubule goes back to glomerulus where it touches it at the vascular pole
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65
Q

Where is the vascular pole located in the renal corpuscle?

A

Where the afferent and efferent enter and exits

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66
Q

What is the distal tubule associated with?

A

The renal corpuscle

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67
Q

What are the specialized cells are the interface of the distal tubule and glomerulus called?

A

The macula densa

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68
Q

What are the cells of the macula densa important for?

A

regulation of control of filtration but not filtration itself

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69
Q

Why compels something to move out of the bloodstream to cross the glomerulus into bowmans capsule and then into the proximal tubule?

A

Starlings forces combined (net filtration pressure)

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70
Q

Are starlings forces unique to the glomerulus?

A

no, they function at any capillary bed

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71
Q

Define Hydrostatic Pressure

A

the pressure exerted by the fluid on the container that contains it. Fluid pushing out against cup

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72
Q

What are the two categories of starlings forces?

A

Hydrostatic and Oncotic Pressure

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73
Q

Define Oncotic Pressure

A

Osmosis generated by proteins in the blood

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74
Q

If there was a container with two fluids (one of water and one with sodium chloride) and a semipermeable membrane what way would the water move?

A

Toward the sodium chloride due to osmosis. (Sodium Chloride generates an osmotic pressure by pulling water across the membrane)

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75
Q

What can generate osmotic pressure?

A

Na+, Cl-, glucose, colloids, proteins

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76
Q

What is a colloid?

A

High molecular weight particle in the ECF

Usually proteins

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77
Q

What are the two hydrostatic pressure?

A

Glomerular hydrostatic pressure and Bowmans space pressure

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78
Q

What is Glomelular (Capillary) Hydrostatic Pressure? (Pc)

A

As blood runs through the glomerulus it is under pressure and it exerts a pressure pushing out

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79
Q

What is bowmans hydrostatic pressure?

A

The pressure of the filterate in bowmans capsule pushing out. Opposes the glomerular hydrostatic pressure

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80
Q

What are the two oncotic pressures?

A

Glomerular colloid oncotic pressure

Bowmans space oncotic pressure (should be very small)

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81
Q

In the renal corpuscle, where is the protein that exerts oncotic pressure?

A

It should be in the blood and not in bowmans space

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82
Q

What is capillary oncotic pressure? (symbol pi subscript c)

A

It is the pressure generated by protein in the blood pushing inward in the glomerulus

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83
Q

Why is the oncotic pressure small in bowmans space?

A

There is only a small amount of protein generating that pressure

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84
Q

What way does the oncotic pressure in bowmans space pull?

A

Out

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85
Q

What way does the hydrostatic pressure in bowmans space pull?

A

in

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86
Q

How do we calculate the net filteration pressure in the glomerulus?

A

Glomerular Hydrostatic Pressure - Bowmans capsule pressure (Hydrostatic) - Glomerular oncotic pressure

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87
Q

Given the following Starlings forces, what is the net pressure at the glomerulus?
Bowmans space hydrostatic pressure = 24 mmHg
Capillary Oncotic Pressure = 26 mmHg
Bowmans space oncotic pressure = 0 mmHg
Capillary Hydrostatic pressure = 58 mmHg

A

58 mmHg - 24 mmHg - 26mmHg = 8mmHg

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88
Q

How does the kidney regulate the rate at which filtrate is generated? (Glomerular filtration rate)

A

The capillary hydrostatic pressure determines the glomerular filtration rate. If it increases so does the filtration rate.

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89
Q

How does the kidney increase or decrease the capillary hydrostatic pressure to change the glomerular filtration rate?

A

Constricting or dilating the arterioles controls how much blood can flow in and out of the glomerulus and then change the capillary hydrostatic pressure. (

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90
Q

Are arterioles a good conduit of blood alone?

A

No, they are small

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91
Q

What do the arterioles at the vascular pole of the renal corpuscle have that aid in changing the filtration rate?

A

Smooth muscle in their walls:
If the smooth muscle tightens the arteriole constricts and less blood flows through (Pc decreases and filtration rate decreases)
If the smooth muscle relaxes, the arteriole expands and more blood can go through.

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92
Q

What happens when the afferent arteriole constricts?

A

Pc decreases and GFR decreases

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93
Q

What are extra renal triggers?

A

They tell the kidney to adjust (constrict or dilate the afferent or efferent arterioles)

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94
Q

What is autoregulation?

A

When an organ detects a change and adjusts to correct it

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95
Q

How does the kidney autoregulate the GFR?

A

As systemic blood pressure increases more blood flows through the kidney and GFR increases but there is a range where the GFR and blood flowing in will not change even if the mean arteriole pressure increases or decreases

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96
Q

What is mean arterial pressure?

A

(x axis) systemic blood pressure

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97
Q

What is Renal Blood Flow?

A

(Y axis) How much blood is flowing through the kidneys

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98
Q

As Mean Arterial pressure increases blood flow ______ and GFR _________

A

As Mean Arterial pressure increases blood flow increases and GFR increases

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99
Q

As more blood flows into the glomerulus capillary hydrostatic pressure ______ and GFR_______.

A

increases, increases

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100
Q

What is the goal of renal autoregulation?

A

To keep blood flow and GFR steady even though systemic BP changes dramatically

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101
Q

Why does the kidney want to autoregulate?

A
  1. Prevents mechanical damage to glomeruli caused by spiking BP
  2. Prevents fluctuations in BP from changing delivery of filtrate to nephron (maintain constant GFR despite changes in BP)
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102
Q

What would happen if the nephron became overwhelmed with the amount of filtrate generated?

A

It could lose some important components in the urine rather than reabsorbing them

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103
Q

What happens to blood pressure and renal blood flow during anesthesia?

A

BP fluctuates while renal blood flow stays steady (autoregulation)

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104
Q

What are the two mechanisms that the kidney autoregulates?

A

Myogenic mechanism

Tubuloglomerular feedback

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105
Q

Describe the Myogenic mechanism

A

The afferant arteriole can sense if it should constrict or dialate based on if its smooth muscle is streched or relaxed and this adjusts the GFR

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106
Q

What happens when smooth muscle is stretched?

A

It contracts

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107
Q

T/F when smooth muscle is not stretched it is contracting

A

False, it is relaxed

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108
Q

If BP is high, the smooth muscle in the afferent arteriole will ________ , intracellular Ca+ will ______, vascular resistance will _________ and the arteriole will ______. Renal Blood flow will _____, _______GFR.

A

If BP is high, the smooth muscle in the afferent arteriole will stretch, intracellular Ca+ will increase, vascular resistance will increase and the arteriole will constrict. Therefore renal blood flow will decrease, decreasing GFR.

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109
Q

If BP is low, the afferent arteriole will ________ , intracellular Ca+ will ______, vascular resistance will _________ and the arteriole will ______. Renal Blood flow will _____, _______GFR.

A

If BP is low, the afferent arteriole will relax and dilate, intracellular Ca+ will decrease, vascular resistance will decrease . Renal Blood flow will increase, increasing GFR.

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110
Q

What is the response time of the myogenic mechanism?

A

1-2 seconds

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111
Q

What is the myogenic response to increased BP?

A

Afferant arteriole constricts

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112
Q

What is the trigger for Tubuloglomerular Feedback?

A

changing distal tubule fluid compositon

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113
Q

What is the response time for Tubuloglomerular Feedback to occur?

A

10-12 seconds (many more steps than the myogenic mechanism)

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114
Q

How does the Tubuloglomerular mechanism work?

A

The macula densa senses changes in the distal tubule fluid caused by fluctuations in the GFR and responds by changing the resistance of arterioles to correct the GFR by regulate the amount of blood

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115
Q

In the tubuloglomerular feedback mechanism of autoregulation what happens when the BP increases?

A

Normally a BP increase will increase Pc and GFR would then increase, due to the increase there is more filtrate. The macula densa senses the higher concentration of ions in the distal tubular fluid and transmit a signal to the wall of the afferent arteriole tell the smooth muscle to constrict and thus reduce the GFR

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116
Q

What does it mean when we say the GFR is increased?

A

More filterate is being dumped into the system.

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117
Q

In the tubuloglomerular feedback mechanism of autoregulation what happens when blood pressure is low?

A

GFR decreases normally due to lower capillary hydrostatic pressure. In the fluid at the distal tubule thereare less ions and the macula densa senses this. It then needs to increase GFR. The efferant arteriole constricts in the presence of angiotensin II released by renin and the afferent arteriole dilates when prostaglandin E2 is sensed and GFR increases

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118
Q

What is the tubuloglomerular response to lower than expected solute concentration in the distal tubule?

A

GFR will be increased

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119
Q

T/F Oxygenated blood from the upper body is returned to the heart via the superior vena cava

A

F-oxygen poor blood is returned

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120
Q

What vessel is blood returned to the heart from the upper body?

A

The superior vena cava

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121
Q

What is the normal resting heart rate for a human?

A

70 bpm

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122
Q

What is the normal arterial pressure for a human?

A

120/80 mmHg

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123
Q

What are the normal hemocrit values for a human male and female?

A 
F = 38-46%
M = 40-54%
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124
Q

What is the top number in BP readings?

A

Systolic

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125
Q

What is the bottom number in BP readings?

A

Diastolic

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126
Q

What is hemacrit?

A

The total number of blood cells in the total blood volume

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127
Q

A normal heart shape and size = what?

A

A normal cardiac cycle

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128
Q

What does dialated cardiomyopathy cause?

A

Congestive heart failure (backflow of blood)

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129
Q

What are the three CV system components?

A
  1. Heart
  2. Blood Vessels
  3. Blood
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130
Q

What does persistant high blood pressure cause?

A

High blood pressure damages the endothelium in the artery causing inflammation. The inflammation causes a plaque formation in the artery. The plaque causes a turbulant blood flow

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131
Q

What is atheroscleric plaque consist of?

A

Lipids, Calcium, Cellular Debris

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132
Q

What is a myocardial infarcation caused by?

A

The fibrous cap in the artery when there is plaque formation breaks and blood flow is hindered causing a heart attack.

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133
Q

What does the plasma contain?

A

WBCs and Platelets

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134
Q

What does coagulation of the blood lead to?

A

Thrombus formation leading to myocardial ischemia or infarcation (zero blood flow)

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135
Q

What is ischemia?

A

Decrease in Blood Flow

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136
Q

Define Hemorrhage

A

You lose the entire RBC including its membrane from the body

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137
Q

Hemolysis

A

RBC membrane ruptures

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138
Q

What can cause Hemorrhage or hemolysis?

A

Trauma, Major Surgery, Hemolytic Anemia or Hemophilia

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139
Q

How is cardiac muscle different than skeletal muscle in a histological sample?

A

Branching of fibers and intercalcated discs (At the tissue level)

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140
Q

What does it mean when we say cardiac muscle is a syncytium?

A

Many cells joined together allowing for fast conduction of action potentials from cell to cell

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141
Q

What does the distinct features of cardiac muscle allow for?

A

Resist fatigue and contract in a corrdinated fashion

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142
Q

What feature of cardiac muscle is important for pumping blood throughout the entire CV system?

A

Rapid, involuntary contraction and relaxion

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143
Q

What is responsible for providing low electrical resistance in cardiac muscle?

A

Intercalcated discs

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144
Q

Describe the pathway of blood to and from the heart

A

1.Low oxygenated blood
-superior vena cava
from upper limbs
-inferior vena cava from lower limbs into the right atrium
2. right atrium
3. tricuspid valve
4. right ventricle.
5. pulmonary valve
6. pulmonary artery
7. Lungs
Blood Picks up Oxygen

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145
Q

Where does the blood go after gaining oxygen in the lungs?

A

The pulmonary veins into the left atrium of the heart

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146
Q

Describe blood flow through the heart from the left atrium

A
  1. Left atrium
  2. Mitral Valve (Bicuspid)
  3. Left Ventricle
  4. Aortic Valve
  5. Aorta
  6. Circulation
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147
Q

Define cardiac cycle

A

The sequence of events that occur during systole and diastole

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148
Q

Define Systole

A

Cardiac muscle contracts and pumps blood from the ventricles into the arteries (Blood leaves the heart)
1st phase

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149
Q

Define Diastole

A

(Ventricle)Muscle relaxes and chambers fill
Blood returns to the heart
2nd phase

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150
Q

Where is the heart located?

A

Slightly left and center

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151
Q

what do the coronary arteries supply?

A

Oxygenated blood

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152
Q

Where do electrical impulse begin in the heart?

A

At the Sinus Node

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153
Q

What does the conduction system of the heart do?

A

Keeps your heart pumping in a normal rhythum

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154
Q

On the posterior side of the heart what does low oxygenated blood enter?

A

The coronary sinus

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155
Q

How is the heart able to contract without any extrinic stimulation?

A

Through the intrinsic conduction system

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156
Q

Define the hearts intrinsic conduction system

A

It can be described as a group of specialized cardiac muscle cells in the walls of the heart that sends signals to the heart muscle causing it to contract.

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157
Q

Describe the path of the hearts internal conduction system

A
  1. SA node
  2. Internodal pathways
  3. AV node
  4. AV bundle
  5. Left and Right bundle branches
  6. Purkinje fibers to ventricle
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158
Q

What happens at the AV node

A
  1. Impulse is delayed

2. The delay allows atria to contract before ventricles

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159
Q

Where does the AV bundle take the electrical impulse?

A

Into the Ventricles

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160
Q

Where are the left and right bundle branches located?

A

Interventricular Septum

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161
Q

What is the other name for the sinus node

A

pacemaker node

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162
Q

What is the function of the SA node?

A

Signals the atria to contract

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163
Q

What is the primary function of the AV node?

A

To cause the ventricles to contract

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164
Q

What is the pacemaker potential?

A

Rhythmic discharge of Sinus Atrial nodal fiber

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165
Q

How many discharges are there in a minute at the SA node?

A

70-80

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166
Q

Which has a higher action potential in millivolts, the Sinus nodal fiber or ventricular muscle fiber?

A

Ventricular

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167
Q

What does the AV node do to the impulse conduction?

A

Slows it considerably to allow sufficient time for the atrial depolarization and contraction (systole) before the ventricle

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168
Q

Why don’t the purkinje fibers need to discharge as frequently as the AV node?

A

They are located very close to the muscle

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169
Q

What is depolarization?

A

Membrane potential increases

Phase 0 –>Fast Na+ channels open, then slow Ca++ open

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170
Q

Describe phase zero of ventricular muscle action potential

A

It is the phase where depolarization occurs and the fast sodium ion channels open and then the slow Calcium ion channels open. There is a sharp increase in membrane potential from negative to positive

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171
Q

Descibe what happens at phase 1 of ventricular muscle action potential

A

Slight repolarization

  • apex of the graph
  • K+ channels open
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172
Q

What happens in phase 2 of Ventricular AP?

A

There is a plateau

  • slower Ca++ channels open,
  • decreased permeability to K+
  • Membrane potential decreases but it is still postive
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173
Q

What happens in phase 3 of ventricular AP?

A

Repolarization

  • more K+ channels open
  • Membrane potential decreases to about -50
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174
Q

What happens in phase 4 of ventricular ap?

A

Resting membrane potential is acheived

-85-95 mV

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175
Q

How long does an action potential take in the ventrcle?

A

about 1.75 second

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176
Q

What does calcium flowing into the cell cause?

A

Coordinated contraction

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177
Q

What does a S-T Segment elevation mean?

A

possible myocardial infarcation

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178
Q

What does the P wave of the ECG coorospond to?

A

Atrial depolarization

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179
Q

What does the QRS complex of the ECG corrospond to?

A

Ventricles depolarizing

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180
Q

What segments of the ECG does an R-R interval include?

A

RSTPQR -a full cycle

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181
Q

What is the Q-T interval on the ECG?

A

QRST

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182
Q

How long is a P-R interval

A

0.16 seconds

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183
Q

What does a T wave on an ECG indicate?

A

When the heart is being primed to relax

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184
Q

How does the heart speed up?

A

The sympathetic nervous system….

  1. Norepinephrine is released at the synapse
  2. Sinus node discharge increases
  3. Impulse conduction rate increases
  4. Force of contraction into atria and ventricles increases
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185
Q

What system is responsible for the heart rate to slow down?

A

Parasympathetic (Vagus cranial nerve X)

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186
Q

What is released to slow the heart rate?

A

Acetylcholine

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187
Q

What is the SA node and AV junctional fibers innervated by to slow the heart rate?

A

The vagus nerve (X)

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188
Q

When Ach is relased at the SA and AV junctional fibers what occurs?

A

Increased permeability of K+ causing hyperpolarization

  • rate of conduction impulse decreases
  • Decrease in force of contraction in atria and ventricles
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189
Q

What do we measure on the Y axis of the cardiac cycle?

A

Volume and pressure (Ventricular and Atrial volume and pressure)

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190
Q

What is the lub sound corrospond to?

A

Systole

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191
Q

What does the Dub sound corrospond to?

A

Diastole

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192
Q

Contraction ______ the pressure within a chamber

A

Increases

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193
Q

Blood Flows from ____ to ______ pressure.

A

Higher to Lower

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194
Q

Semilunar valves open when ______

A

Ventricular pressures are higher than aortic pressure

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195
Q

AV valves _____ when atrial pressures are ______ than ventricular pressure.

A

Open, higher

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196
Q

What is the first heart sound?

A

S1

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197
Q

What is each cardiac cycle initiated in?

A

The SA Node

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198
Q

How do you find the duration of the cardiac cycle?

A

Take the reciprocal of heart rate

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199
Q

What phase is ventricular systole?

A

Phase 1

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200
Q

How long does ventricular systole last?

A

0.3 seconds

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201
Q

What happens during phase 1: Ventricular Systole?

A
  1. Isovolumic contraction

2. Ventricular ejection

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202
Q

Define ventricular systole

A

Contraction in the ventricular myocardium

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203
Q

What happens during phase 2 of the cardiac cycle?

A

Diastole

204
Q

What is diastole?

A

Relaxtion of the ventricular myocardium

205
Q

How long is diastole?

A

0.4 sec

206
Q

What are the steps in diastole?

A
  1. Isovolumeric relaxation
  2. Rapid inflow
  3. Diastasis
  4. Atrial Systole
207
Q

What is atrial systole?

A

Contraction of the myocardium (rt. and left atria)

208
Q

How long does atrial systole last?

A

0.1 sec

209
Q

Why does atrial systole occur during diastole?

A

Some blood volume is being deposited into the ventricles prior to ventricular systole

210
Q

What happens during isovolumic contraction?

A

First step of Sytole- 1.The ventricular pressure rises rapidly without a change in volume
2. All valves are closed

211
Q

What do you hear during isovolumeric contraction?

A

The AV valves snap shut and you hear the lubb sound (S1)

212
Q

What is reabsorption?

A

The movement of molecules in the tubular fluid accross the epithelial lining of the nephron back into the bloodstream via the peritubular capillary network

213
Q

After going through the peritubular capillary network in the kidney where does the blood go?

A

Dumps into the renal vein to exit the kidney

214
Q

What is the oppostite of reabsoption when talking about the kidney?

A

Secretion

215
Q

What is the opposite of reabsoption when talking about the kidney?

A

Secretion

216
Q

In the kidney, what is the luminal membrane>

A

Seperates tubular cell from tubular fluid

217
Q

In the kidney, what is the basolateral membrane?

A

The other side of the cell, seperates the cell from the peritubuler interstitium

218
Q

What is the goal of reabsorption?

A

To move stuff from the lumen of the tubular cells to the blood

219
Q

What part of the cell directly interacts with the filterate produced in the kidney?

A

The luminal membrane

220
Q

what are the pathways from the luminal membrane to the blood in kidney reabsorption?

A

Transcellular route and paracellular route

221
Q

Describe the transcellular route in reabsorption

A

Reabsorption through the cytoplasm of tubular cells (Through cells)

222
Q

Describe the paracellular route of reabsorption in the kidney

A

Reabsorption between tubular cells across tight junctions (Between Cells)

223
Q

What pathway is used for the majority of reabsorption in the kidneys?

A

Transcellular

224
Q

Define passive transport

A
  • no energy required

- moves down an electrochemical gradient (alot of molecules to less molecules)

225
Q

What are the types of passive transport?

A

Diffusion and facilitated diffusion

226
Q

What types of things move using facilitated diffusion?

A

molecules that don’t easily cross biological membranes (Charge, polar (inbalance of charge) (Na, K, Mg, glucose)

227
Q

What does facilitated diffusion require?

A

a transporter

228
Q

What is a polar molecule?

A

A molecule with an uneven distribution of charge (Glucose)

229
Q

What is active transport?

A
  • Energy required

- Moves against an electrochemical gradient (low to high)

230
Q

What are the types of active transport?

A

Primary and Secondary

231
Q

What is all reabsorbtion linked in some way to?

A

NaK+ ATPase

232
Q

Where is Na K+ATPase located?

A

Basolateral membrane

233
Q

Where is NaK+ATPase not located in the basolateral membrane in the kidney?

A

Loop of henle

234
Q

Is there a difference in concentration of molecules that are found in the filterate vs. the molecules in the interstiticial fluid?

A

No there is no gradient

235
Q

What makes the nephron tick?

A

The energy in NaKATPase

236
Q

How many sodium and potassium molecules does NaK+ATPase move?

A

3 Na+ ions out and 2 K+ ions in

237
Q

Does ATPase require energy?

A

Yes

238
Q

What is the Na K+ATPase mechanism in the basolateral membrane in the kidney?

A

To pump 3 Na+ out energy is required because it is moving against its electrochemical gradient

239
Q

What is the Na K+ATPase mechanism in the basolateral membrane in the kidney?

A

To pump 3 Na+ out energy is required because it is moving against its electrochemical gradient but since Na is going out an electrochemical gradient is generasted

240
Q

What is the function of NaKATPase in tubular reabsorption?

A

Maintains low intracellular Na+ to establish the electrochemical gradient up which all reabsorption depends

241
Q 
Which of the following statements about Na+K+ATPase is correct?
A
It transports Na+ and K+ at the luminal membrane of nephron epithelia
B
It moves 3 Na+ into the cells in exchange for 2 K+ out of the cell
C
Na+ movement is by facilitated diffusion
Correct
D
It requires energy in the form of ATP
E
It moves K+ paracellularly
A

D

242
Q

What does the proximal tubule reabsorb?

A 
67% of filtered water
Na
Solutes
99% of filtered glucose
Amino Acids
90% bicarbonate
243
Q

What reabsorbs most water?

A

Proximal tubule

244
Q

What can get secreted from the proximal tubule?

A

Bases, protons, organic acids

245
Q

What special features do you find in the cells of the proximal tubule that tell you its function?

A

Brush Border-microvilli-increases surface area realitive to volume
Mitochondria-generates ATP

246
Q

What part of the membrane has the brush border in the proximal tubule?

A

Lumen

247
Q

What type of transport goes on in the proximal tubule?

A

Active-Mitochondria indicate that ATP is being made

248
Q

Where is the Na K ATPase located in the cells at the proximal tubule?

A

Basolateral membrane

249
Q

Describe the mechanism of action in the cells of the proximal tubule by where Na is reabsorbed

A
  1. NaKATPase pumps 3 Na ions out which creates a concentration gradient at the lumen membrane of the cell.
  2. This allows Na to enter the cell via facilitated diffusion at the lumenal membrane
  3. Sodium goes in and then is pumped out by NaKATPase (reabsorbed)
250
Q

How does glucose enter the cell in the proximal tubule ?

A
  • Secondary active transport by using the ATP (potential energy) that was generated by NaKATPase moving sodium out of the cell
  • Glucose transporters move glucose
251
Q

Where do transporters move glucose and amino acids into the cell?

A

At the basolateral membrane

252
Q

How to amino acids enter the cell at the proximal tubule?

A

Secondary active transport

253
Q

What are Na proton exhangers?

A

a secondary transporter

254
Q

How does water enter the cell at the proximal tubule?

A

It is pulled with sodium by osmosis by NaKATPase

255
Q

In the first half of the proximal tubule, why does chloride concentration build up?

A

Water is leaving and chloride is staying in the tubular fluid

256
Q

What happens to chloride concentration in the second half of the proximal tubule?

A

Since it built up in the first half, there is now a concentration gradient for chloride and so chloride can move between cells by simple diffusion paracellularly into the blood. This only happens because Water was reabsorbed and water can move because of Na ion reabsorbtion

257
Q

What happens in the last part of the proximal tubule?

A

Cl- attracts Na+ paracellularly and more sodium is reabsorbed

258
Q

What does the loop of henly reabsorb?

A

25% of filtered NaCl and 15% of filtered water

259
Q

Where does water reabsorption occur in the loop of henle?

A

descending limb

260
Q

In the loop of henly is NaCl reabsorption passive or active?

A

passive

261
Q

Where is NacL reabsorped in the loop of henle?

A

ascending limb

262
Q

Where does the descending limb of the loop of henle go?

A

to the medulla

263
Q

Where does the ascending limb of the loop of henle go?

A

To the cortex

264
Q

What part of the loop of henle is permeable to water?

A

Descending Limb

265
Q

What part of the loop of henle is permeable to sodium and chloride?

A

Ascending

266
Q

What type of reabsorption occurs at the loop of henle?

A

passive

267
Q

What type of cells line the proximal tubule epithelium?

A

Low cuboidal

268
Q

What type if cells line the loop of henle epithelialum?

A

Simple squamous Epitheilium

269
Q

Is there mitochondria in the cells of the loop of henle?

A

not many as no energy is needed

270
Q

Is Cl- absorbed paracellularly or transcellularly in the proximal tubule?

A

both-paracellularly at the proximal tubule and transcellularly at the loop of henle

271
Q

How much water is reabsorbed at the distal tubule and collecting duct?

A

9-15%

272
Q

How much NaCl is reabsorbed at the distal tubule and collecting ducts?

A

7%

273
Q

What does water permeability depend on at the distal tubule and collecting duct?

A

ADH must be present

274
Q

What cell type is found in the distal tubule?

A

cuboidal

275
Q

What is the job of the nephron at the distal tubule and collecting duct?

A

Fine tuning

276
Q

What is reabsorbed at the distal tubule?

A

Na, K, Cl, ions

277
Q

What is secreted at the distal tubule?

A

protons

278
Q

In the distal tubule what are features of the cell?

A

Smaller brush border, some mitochondria

279
Q

What happens in the early part of the distal tubule (straight tubule)?

A

There is a very strong lumen postitve potential difference (fluid that runs is positively charged paracellularly) That repels other positively charged ions and they move paracellularly

280
Q

In the straight distal tubule (early) what is the transcellular method of reabsorbtion at the Lumenal membrane?

A

NaKATPase moves Na out but there is another molecule called NaKCC2 that can move 1 ion of Na, 1 ions K and 2 ions of chloride into the cell. This is based on the movement of Na.

281
Q

How is Cl- moved into the cell at the basolateral membrane?

A

Cl- channels

282
Q

What happens in the convoluted distal tubule(late)?

A

NaKATPase works at the basolateral membrane and a sodium chloride symporter works at the luminal membrane moving sodium and chloride in and chloride is then reabsorbed via chloride channels at the basolateral membrane

283
Q

What transports Na+ at the luminal membrane of the late distal tubule?

A

Na-Cl symporter

284
Q

What type of cells are found in the collecting duct in the cortex?

A

Principal cells and intercalcated cells

285
Q

What do principal cells absorb?

A

Na, K+ and some Cl-

286
Q

What is the function of intercalcted cells found in the collecting duct

A

Move protons and Bicarbonate (regulate pH)

287
Q

In the medullarly collecting duct what type of cells are found?

A

Only principal cells

288
Q

What do principal cells look like?

A

Lighter in color cuboidal

289
Q

Where do you find larger collecting ducts?

A

In the medulla

290
Q

What is the major mechanism for reabsorbtion in the collecting duct?

A

Ions moved basically via channels at the luminal membrane along with NaK ATPase at work in the basolateral membrane

291
Q

How is tubular reabsorption regulated?

A
  1. Glomerulotubular balance
  2. Starlings forces at the peritubular capillary bed
  3. Hormones
292
Q

How does Glomerulotubular balance work?

A

The more filterate dumped into proximal tubule, the more reabsorbed so as GFR increases, so does reabsorption

293
Q

How do starlings forces at the peritubular capillary bed regulate reabsoption?

A

Normally promote reabsorption in the proximal tubule

Changes in the capilarry pressure and osmotic capillary pressure will change reabsorbtion

294
Q

How can hormones regulate reabsorption?

A
  1. Increase activity

2. Increase the number of transporter molecules

295
Q

Define Osmolarity

A

It is the concentration of osmotically active atoms per L of solvent.

296
Q

What way does water move in the presence of a high osmolarity substance such as NaCl?

A

Toward the higher osmolarity substance

297
Q

In the loop of henle where is it permeable to Na+ and impermeable to water?

A

ascending limb

298
Q

In terms of osmolarity, what is the fluid leaving the proximal tubule defined as?

A

isoosmotic (300 MOsm/kg)

299
Q

What creates an osmotic gradient in the distal straight tubule?

A

The active reabsorbtion of Na+. Water follows the Na+ as it is being reabsorbed leaving the descending limb passively (without the use of energy) of the loop of henle

300
Q

Where does osmolality increase in the loop of henle?

A

The Medullary interstitium-Na+ leaves the ascending limb contributing to osmolality. It leaves passively

301
Q

What happens in the hairpin loop in the loop of henle?

A

Water reabsorption has concentrated Na+ above interstitial concentration so now there is a Na+ gradient

302
Q

In terms of osmolarity, how do you describe the fluid going into the distal tubules at the end of the loop of henle?

A

Hypoosmotic

303
Q

Where are osmoreceptors located?

A

Hypothalamus

304
Q

What do osmoreceptors do?

A

Shrink and swell to detect changes in osmolality

305
Q

What do baroreceptors do?

A

Detect changes in plasma volume or pressure

306
Q

What happens when ADH is low?

A

A high volume of dilute urine is produced

307
Q

What happens when ADH is high?

A

Antidiuresis, where there is a low volume of concentrated urine produced

308
Q

What preserves medulla hypeosmolarity?

A

The vasa Recta

309
Q

What is an effective osmole?

A

It can generate osmotic pressure

310
Q

In the descending limb of the loop of henle what is the osmolarity in side the limb when compared to the intersticial fluid?

A

It is lower inside the limb so water moves out to the intersticial fluid

311
Q

What is countercurrent multiplication?

A

The thing in the loop of henle in the descending limb causes the opposite effect in the ascending limb

312
Q

Which statement about physiology at the loop of Henle is true?
Na+ is reabsorbed passively at the descending limb
B
Water is reabsorbed down an osmolarity gradient (low to high osmolarity)
C
Interstitial osmolarity decreases as you move deeper into the medulla
D
Distal tubule fluid is hypertonic to insterstitium

A

B

Water is reabsorbed down an osmolarity gradient (low to high osmolarity)

313
Q

What are the triggers to produce ADH?

A

Low volume (Osmoreceptors detect shrinking) and Low pressure (Baroreceptors detect Pressure)

314
Q

what is the PRIMARY determinent of the release ADH?

A

Osmoreceptor response

315
Q

What is the response in the late distal tubule and collecting duct to ADH release?

A
  1. Increase expression of aquaporins in the luminal membrane of the late distal tubule and entire collecting duct so water can be reabsorbed.
  2. Increase number of urea transporters in the luminal membrane of the medullary collecting duct so urea it is permeable to urea
316
Q

What is the other word for ADH?

A

Vasopressin

317
Q

Does ADH affect filteration in the nephron?

A

no

318
Q

What happens when there is low ADH?

A

Diuresis and water is trapped in the distal tubule and collecting duct. A high volume of dilute urine is produced

319
Q

What happens when ADH is high?

A

Antidiuresis-Water is reabsorbed and urine is concentrated

320
Q

What is urea?

A

By product of protein metalbolism

321
Q

Is urea an effective osmole in the collecting duct?

A

no just in the loop of henle

322
Q

During diuresis, which of the following is true?
A
Urea reabsorption in medullary collecting duct is high
B
Collecting duct permeability to water is low
C
Water reabsorption at loop is increased
D
A small volume of urine is produced

A

B

Collecting duct permeability to water is low

323
Q

What is the vasa recta?

A

A group of capillaries around the late distal tubule and collecting duct

324
Q

What is the function of the vasa recta?

A

To preserve medullary hyperosmolarity by keeping solutes

325
Q

What is the main ECF ion?

A

Na+

326
Q

What is changed by changing the amount of Na+?

A

ECF volume

327
Q

What is changed by changing the concentration of Na+?

A

ECF osmolarity

328
Q

What needs to be regulated to control the osmolarity and volume of the extracellular fluid?

A

ECF Na+

329
Q

Where is most of the Na+ located in the body?

A

Extracellular (ECF)

330
Q

Where does most of the K+ live in the body?

A

intracellularly

331
Q

What do you find in the cell

A

Mg++,K+ , PO4, protein

332
Q

Where do you find most Cl- in the body?

A

Extracellularly

333
Q

Where do you find most bicarbonate?

A

Extracellularly

334
Q

What is the derterminant of ECF osmolarity?

A

Na+ concentration

335
Q

High ECF Concentration is called

A

Hypernatremia

336
Q

What are the signs of hypernatremia?

A

Rupture of cerebral vessels
Muscle weakness
Ataxia,behavioral change
Coma to death

337
Q

What is low Na+ ECF Concentration called?

A

Hyponatremia

338
Q

What are the signs of Hyponatremia?

A

Incoordination and seizures

339
Q

What is concentration?

A

The amount of a specified substance (Na+) in a unit amount of another substance (water)

340
Q

What detects change in ECF osmolarity

A

osmoreceptors in the pituitary gland

341
Q

When there is high ECF osmolarity what do the osmoreceptors do?

A

Shrink

342
Q

What are the effects of osmoreceptor shrinkage

A

ADH release and Thirst Body, ADH is released and aquaporins are made thus reabsorption of water takes place and ECF osmolarity decreases

343
Q

What occurs when there is more ECF in volume?

A

Hypervolemia (ascites and pulmonary edema)

344
Q

What happens when ECF volume is too low?

A

Hypovolemia-Hypovolemic shock, organ damage

345
Q

What can cause a volume change in ECF?

A

Na+, Blood loss, vomiting, liver failure

346
Q

What do kidneys do to when it detects a volume change of ECF.

A

Regardless of cause, they change the amount of ECF Na+ to correct the volume

347
Q

Does the kidney regulate protein?

A

no, the liver

348
Q 
What will be the effect of increasing extracellular fluid sodium concentration?
A
ECF volume will go down
B
ECF volume will go up
C
ECF osmolarity will go down
D
ECF osmolarity will go up
A

D

ECF osmolarity will go up

349
Q

Where is the thirst center in the brain?

A

Hypothalamus

350
Q

Which statement about hyponatremia is most accurate?
A
A hyponatremic individual will have high ECF Na+ concentration
B
There will likely be translocation of fluid from ECF into ICF
C
Osmoreceptors in hypothalamus will shrink
D
ADH release will be increased
E
The individual will feel thirsty

A

B

There will likely be translocation of fluid from ECF into ICF

351
Q

What is more serious hypervolemia or hypovolemia?

A

Hypovolemia

352
Q

How does the kidney detect volume change in the ECF?

A
  1. Baroreceptors

2. Juxtaglomerular Apparatus

353
Q

Where are baroreceptors located?

A

Heart (mostly right side), aorta, carotid sinus

354
Q

What do baroreceptors sense?

A

Stretch (increase in volume)

355
Q

When the baroreceptors stretch what is the response?

A

Sympathetic nervous system and natriuretic peptide release(decreases a high ECF volume)

356
Q

How does the juxtaglomerular Apparatus regulate ECF volume?

A

It has stretch receptors that stretch when ECF volume goes up.

357
Q

Where is the juxtoglomerular apparatus located?

A

By the afferant arterioles

358
Q

How does the juxtoglomerular apparatus increase a low ECF fluid?

A

The Renin-Angiotensin system

359
Q

How do we increase ECF volume?

A

When low ecf is detected the 1. sympathetic nervous system increases Na+ reabsorption ECF volume
2. Increases GFR and Pic and Pc is reduced of the peritubular capillaries of the proximal tubule to increase rebsorbtion

360
Q

What does the sympathetic nervous system specifically do in when ecf volume is low?

A

norepinephrine constricts the efferant arteriole which builds capilary hydrostatic pressure within the glomerulus and the GFR increases promoting the movement of sodium back into the bloodstream

361
Q

What triggers the renin -angiotensin mechanism?

A

The afferant arteriole detects stretch and Low ECF volume triggers the release of renin from the juxtaglomerular cells

362
Q

What happens when renin is released?

A

Angiotensin II is increased and Na+ reabsorbtion is increased

363
Q

Describe the renin angiotensin mechanism

A
  1. Angiotensinogen is produced in the liver and enters the blood stream
  2. When it encounters renin, renin cleaves angiotensenogen to angiotensin I
  3. Angiotensin I sits in the blood stream until it encounters Angiotensen converting enzyme
  4. This enzyme cleaves it to angiotensin II
364
Q

Where is angiotensin converting enzyme produced?

A

In the lungs

365
Q

What does angiotensin II do?

A
  1. Potent vasoconstrictor that changes starlings forces in peritubular capillaries
  2. Stimulate Aldosterone which increases Na+ reabsorbtion via NaK+Atpase
366
Q

Where is aldosterone found?

A

Adrenal gland

367
Q

How is ECF Volume decreased?

A

Natriuretic peptides inhibit the ways sodium can be reabsorbed and it promotes Na excretion through the urine

368
Q

What is the mechanism of natriuretic peptide release?

A

it inhibits renin-angiotensin II, aldosterone and Na+ channels in the collecting duct all decreasing renal Na+ reabsorption

369
Q

Which statement about hypovolemia is accurate?
A
It is defined as high ECF volume
B
It is caused by low ECF Na+ concentration
C
In response, sympathetic flow to the kidneys is increased
D
To correct it, the Renin-Angiotensin system will be inhibited

Submit

A

In response, sympathetic flow to the kidneys is increased

370
Q

An increase in afterload causes stroke volume to

A

Decrease

371
Q

What does the cardiac cycle refer to?

A

The sequence of events that occur with every heartbeat

372
Q

What are the two major phases of the cardiac cycle?

A

Systole and Diastole

373
Q

What does Systole refer to?

A

Ventricular contraction

374
Q

What does diastole refer to?

A

Ventricular relaxation

375
Q

Valves open and close according to _______

A

pressure gradients

376
Q

Contraction ________the pressure

A

Increases

377
Q

Blood flows from ____ to ______ pressure

A

Higher to lower

378
Q

Semilunar valves open when Ventricular pressures are _____ than aortic pulmonary pressures

A

Higher

379
Q

AV valves ______when atrial pressures are ____ than ventricular pressure.

A

Open, higher

380
Q

How is the cardiac cycle initiated?

A

When the SA node fires(p wave)

381
Q

What happens to the pressure when contraction begins?

A

Pressure increases in the atrium and blood flows through the AV valve to the ventricle

382
Q

T/F atrial contraction is responsible for filling the entire ventricle

A

False-it only accounts for a fraction of the filling as the ventricles already have some blood in them.

383
Q

What causes the AV valves to close?

A

A decrease in atrial pressure

384
Q

What marks the beginning of systole?

A

Closing of the AV valves (S1 heart sound)

385
Q

At the beginning of ventricular contraction, are the semilunar valves open?

A

No they are closed and the ventricle contracts in a closed space

386
Q

What is isovolumetric contraction?

A

Semilunar valves are closed while ventricle contracts, no blood is ejected and pressure in the ventricle is unchanged

387
Q

When does ventricular ejection start?

A

When ventricular pressures exceed the pressures within the aorta and pulmonary artery

388
Q

what valves open to allow ejection from the ventricles?

A

pulmonary and aortic

389
Q

What produces the second heart sound?

A

Closing of the semilunar valves

390
Q

Where is each cardiac cycle initiated?

A

SA Node

391
Q

What is phase 1 of the cardiac cycle called?

A

Ventricular Systole

392
Q

What steps occur during ventricular systole?

A
  1. Isovolumic contraction

2. Ventricular ejection

393
Q

What is phase 2 of the cardiac cycle called?

A

Diastole

394
Q

What steps occur during diastole?

A
  1. Isovolumic relaxation
  2. Rapid inflow
  3. Diastasis
  4. Atrial Systole
395
Q

What happens during atrial systole?

A

More blood is being deposited into the ventricles

396
Q

What happens to ventricular pressure during step 1 of the cardiac cycle isovolumeric contraction?

A

It rises rapidly without a change in volume

397
Q

Are the valves open or closed during isovolumic contraction?

A

All 4 are closed

398
Q

Which heart sound is the loudest?

A

S1 because the pressure is going to be the highest

399
Q

When the bicuspid valve is closed what is the chordae tendiae and papillary muscles doing?

A

Paillary muscle is contracted and chordae tendinae are taut

400
Q

What happens to ventricular pressure in step 2 of phase 1 (Ventricular Ejection)?

A

Left ventricular pressure is greater than aortic pressure and the right ventricular pressure is greater than the pulmonary trunk pressure

401
Q

What valves open during step 2 of phase 1 ,Ventricular Ejection?

A

Semilunar

402
Q

On the ECG What is happening during the T wave?

A

Ventricular ejection

403
Q

What is end systolic volume (ESV)

A

The amount of blood remaining in the ventricle after systole (50 ml)

404
Q

How do you calculate stroke volume?

A

SV = EDV-ESV

405
Q

What is the stroke volume output into the aorta and pulmonary trunk?

A

70 mL

406
Q

What happens to aortic pressure during ventricular ejection?

A

It starts increasing during systole after the aortic valve opens

407
Q

When does aortic pressure decrease during ventricular ejection?

A

Toward the end of the ejection phase

408
Q

What happens to atrial pressure during ventricular ejection?

A

C wave- there is a slight backflow of blood into the atria

409
Q

What happens to ventricular volume during isovolumic relaxion?

A

Stays the same

410
Q

What do the valves do during isovolumic relaxation ?

A

They close (all 4)

411
Q

What sound do you hear when isovolumic relaxation occurs?

A

S2-the Dupp sound

412
Q

What is happening when you hear the Dupp sound?

A

Semilunar valves are closing (pressure in the ventricle decreases and blood flows back to the ventricles which closes the semilunar valves

413
Q

What happens to ventricular volume during the rapid inflow phase of diastole?

A

Increases

414
Q

What happens to ventricular pressure during the rapid inflow phase of diastole?

A

it is low due to the AV valves being open and rapid ventricular filling and blood flowing continually from the great veins in the atria

415
Q

How much blood flows directly through the atria into ventricles before atrial systole?

A

80%

416
Q

What happens to atrial pressure during the rapid inflow phase of Diastole?

A

There is a slow venous return of blood into atria from veins while AV valves are closed

417
Q

What is a V wave?

A

It is the end of ventricular contraction

418
Q

What happens to aortic pressure during the rapid inflow phase of diastole?

A

Decreases slowly due to elasticity of the aorta and blood flow to the periphery.

419
Q

What will you see on the graph during rapid inflow during diastole?

A

An incisura on the aortic pressure due to the sudden cessation of back flow toward the left ventricle

420
Q

What happens during the diastasis stage of diastole?

A

A small amount of blood passively flows into the ventricles

421
Q

On an ECG what occurs during diastasis?

A

A P wave

422
Q

What do you see on an ECG during atrial systole?

A

QRS complex

423
Q

What happens to ventricular volume during atrial s during atrial systole?

A

Increases by 20% and the end diastolic volume of each ventricle is 120 ml

424
Q

What is the end diastolic volume of each ventricle?

A

120 ml

425
Q

What happens to ventricular pressure during atrial systole?

A

It increases slightly

426
Q

What do you see on the atrial pressure graph during atrial systole?

A

A small wave occurs on the graph due to atrial contraction

427
Q

During atrial systole that occurs during diastole what is happening?

A

Atria contract and this accounts for 20% of ventricle filling during the cardiac cycle.

428
Q

What do atria function as during atrial systole?

A

A primer pump or kick that increases ventricular pumping effectiveness by 20%

429
Q

What happens to aortic pressure during atrial systole?

A

It decreases slightly

430
Q

During the Ventricular Systole in the isovolumic contraction step, What do the valves do?

A

AV valves close and semilunar valves close

431
Q

During the Ventricular Systole in the isovolumic contraction step, What do you hear?

A

S1 heart sound (Lubb)

Closure of AV valves

432
Q

During the Ventricular Systole in the isovolumic contraction step, What is the ventricular volume?

A

120ml

433
Q

During the Ventricular Systole in the isovolumic contraction step, What is ventricular pressure?

A

Rapid increase from 0-90 mmhg

434
Q

During the Ventricular Systole in the isovolumic contraction step, What is the aortic pressure?

A

80 mmhg

435
Q

During the Ventricular Systole during Ventricular ejection What do the valves do?

A

AV valves close and semilunar valves open

436
Q

During the Ventricular Systole during Ventricular ejection What do you see on a ECG?

A

A T wave

437
Q

During the Ventricular Systole during Ventricular ejection, what is the ventricular volume?

A

ESV=50 mL

SV=70 ml

438
Q

During the Ventricular Systole during Ventricular ejection What is the ventricular pressure?

A

Increases from 90-120 mmhg

439
Q

During the Ventricular Systole during Ventricular ejection What do the valves do?

A

120 mmhg

440
Q

During Diastole, During isovolumeric relaxation (Phase 3) What do the valves do?

A

AV valves close and semilunar valves close.

441
Q

During Diastole, During isovolumeric relaxation (Phase 3) What heart sound do you hear?

A

S2-(Dupp)-semilunar valves closing

442
Q

During Diastole, During isovolumeric relaxation (Phase 3) What is the ventricular volume?

A

Decreased from previous stage to 50 ml

443
Q

During Diastole, During isovolumeric relaxation (Phase 3) What is the ventricular pressure?

A

Rapid decrease from 90-0mmhg

444
Q

During Diastole, During isovolumeric relaxation (Phase 3) What is the aortic pressure?

A

You will see an incisura on the graph and it is 100 mmhg

445
Q

During Diastole, During Rapid inflow (Phase 4) What do the valves do?

A

AV valves open

Semilunar valves close

446
Q

During Diastole, During Rapid inflow (Phase 4) What is the ventricular volume?

A

50-90 ml

447
Q

During Diastole, During Rapid inflow (Phase 4) What is the aortic pressure?

A

Decreases from 100-90 mmhg

448
Q

During Diastole, During Diastasis (Phase 5) What do the valves do?

A

AV Valves open and Semilunar valves close

449
Q

During Diastole, During Diastasis (Phase 5) What do you see on a ECG?

A

A p wave

450
Q

During Diastole, During Diastatis(Phase 5) What is the ventricular volume?

A

90-96 ml

451
Q

During Diastole, During Diastasis(Phase 5) What is the aortic pressure?

A

Decreases 90-85 mmhg

452
Q

During Diastole, During Atrial systole(Phase 6) What do the valves do?

A

AV valves open and semilunar valves close

453
Q

During Diastole, During Atrial systole (Phase 6) What do you see on an ECG?

A

QRS complex

454
Q

During Diastole, During Atrial systole(Phase 6) What is the ventricular volume?

A

Adds 24 ml so EDV = 120 ml

455
Q

During Diastole, During Atrial systole(Phase 6) What is the ventricular pressure?

A

0 mmhg

456
Q

During Diastole, During Atrial systole(Phase 6) What is the aortic pressure?

A

Decreases 85 to 80mmhg

457
Q

What is stroke volume?

A

The amount of blood pumped from each ventricle

458
Q

What is cardiac output?

A

The amount of blood pumped from each ventricle per minute

459
Q

What is ejection fraction?

A

How well the heart is pumping, what is the percentage of blood ejected by the ventricles each contraction.

460
Q

What number does the American heart association use for staging heart failure?

A

Ejection fraction

Normal is 55-60%

461
Q

What are three factors that regulate stroke volume?

A
  1. Preload
  2. Afterload
  3. Contractility
462
Q

What volume do we want to regulate so there are equal amounts?

A

Ventricular volume

463
Q

What is the external work of the heart?

A

The work required for normal stroke volume

464
Q

What is preload?

A

the degree of tension (amt. of stretch) on the myocardium when it begins to contract

465
Q

What does the frank starling mechanism refer to?

A

Greater stretch on cardiac muscle fibers prior to contraction increases force of contraction (stretching and releasing a rubber band)

466
Q

What is preload measured as?

A

Measured as End diastolic pressure when ventricle is filled with blood = (EDV)

467
Q

What is the cause of increased pre-load?

A

Increased stroke volume caused by hypervolemia, Aortic valve stenosis and regurgitation or pulmonary valve stenosis

468
Q

What are some causes of decreased pre-load (decreased sV)?

A

Atrial Fib

Hemorrhage

469
Q

What is afterload?

A

The pressure that must be overcome before a semilunar valve can open

470
Q

During Afterload pressure in the ventricle needs to be ______pressure in the aorta

A

greater

471
Q

What causes increased afterload?

A

Decreased stroke volume such as atherosclerosis, hypertension, aortic stenosis

472
Q

What causes decreased afterload?

A

increased stroke volume such as mitral valve regurgitation (endocarditis)

473
Q

What does an increased afterload do to the frank starling curve?

A

shifts it down and to the right, which decreases SV (y axis) but increases left ventricular end diastolic pressure (x axis) (LVEDP)

474
Q

An increase in afterload ____the velocity of fiber shortening

A

decreases

475
Q

What does the decrease in fiber velocity shortening do to the rate of volume ejection in the ventricle?

A

reduces it so that more blood is left within the ventricle at the end of systole

476
Q

What are positive inotropic agents?

A

Substances that increase contraction by enhancing Ca2+ inflow during cardiac action potential

477
Q

What do positive inotropic agents stimulate?

A

The sympathetic nervous system (epinephrine and norepinephrine)

478
Q

What does digitalis do?

A

Enhances Ca2+ inflow during cardiac action potential for dilated cardiomyopathy

479
Q

What are negative inotropic agents?

A

substances that decrease contraction by blocking Ca2+ inflow during cardiac action potential

480
Q

What do inotropic agents inhibit?

A

Sympathetic nervous system (anoxia, acidosis, increased K+ in intersticial fluid)

481
Q

What does diltiazem do?

A

It is an enhanced Ca2+ blocker for hypertrophic cardiomyopathy

482
Q

What is dilated cardiomyopathy?

A

Heart cannot contract as well

483
Q

What is ventricular myopathy?

A

Increase in the size and mass of the right or left ventricle

484
Q

Is ventricular myopathy always bad?

A

No, in athletes it enables the heart to pump more effectively. It is physiological and not abnormal. It is reversible

485
Q

What are causes of pathogenic ventricular hypertrophy?

A 
Ventricle adapting to increased stress either increased volume load (preload) or increased pressure load (afterload)
-valve disease
-cardiomyopathies
-genetic abnormalities
coronary heart disease
486
Q

What is concentric hypertrophy?

A

Increase in afterload = chronic pressure overload due to chronic hypertension or aortic valve stenosis

487
Q

Does the ventricular radius always change in concentric hypertrophy?

A

it may not

488
Q

What happens to the heart wall in the ventricle in concentric hypertrophy?

A

wall thickness increases and the ventricle is capable of generating greater forces and higher pressures

489
Q

why is ventricle filling compromised in ventricular hypertrophy?

A

compliance is reduced because ventricle is stiffer

490
Q

what is eccentric hypertrophy?

A

there is an increase in preload (a volume increase) and afterload (increase in pressure) which leads to a volume and pressure overload

491
Q

What happens to the ventricular chamber in eccentric hypertrophy?

A

Ventricular chamber radius is increased and wall thickness may increase

492
Q

What is right sided heart failure?

A

A small amount of blood transfers from the pulmonary circulation to the systemic circulation

493
Q

what increases as a result of right sided heart failure.

A

small increase in atrial pressure and a small increase in cardiac output.

494
Q

What happens to systemic circulation in right heart failure?

A

large volume and capitance

495
Q

What are some symptoms of right sided heart failure?

A

Congested liver leading to ascites
Jugular vein distension
peripheral distension (sweilling in feet and ankles)

496
Q

What is pulmonary circulation?

A

Only in the lungs-it cannot store a lot of blood. it only has small volume and capitance

497
Q

Why is there jugular distention in right heart failure

A

Blood backs up in the superior and inferior vena cava due to the increased volume and pressure but due to gravity it will be mostly towards the inferior vena cava

498
Q

What happens when there is left sided heart failure

A

A large amount of blood transfers from the systemic circulation into the pulmonary circulation and causes a big increase in left atrial pressure

499
Q

Why is there pulmonary edema in left heart failure?

A

due to the pressure increase in the left atria there will be a backup of blood into the bicuspid valve and then into lungs

500
Q

How could we evaluate for heart failure?

A

Could hear it in the lungs, more shallow
radiography
increase in radioopacity will see fluid (cloudy)

501
Q

What would we see in a echocardiogram in left heart failure?

A

Encarditis-inflammation of the endocardium

lines the valve

502
Q

What causes inflammation of the endocardium?

A

Bacteria enter the bloodstream during dental procedures, sx, iv drug use
Bacteria attach to heart valve and there are growths holes and scarring
valves get leaky
leaky valves can become fibrotic and calcified causing stiffness
if they are stiff papillary muscles can stretch or tear

503
Q

How are we able to measure the electrical activity in the heart through electrodes?

A

when heart depolarizes and repolarizes electrical currents spread through the body

504
Q

How many leads in bipolar leads?

A

3

505
Q

What is an ECG?

A

A recording of the electrical difference between 2 leads

506
Q

In lead 1 the right arm is

A

positive

BMS 538 (8 decks)

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