Lecture Flashcards
Gross anatomy of the renal system
kidney, ureters, bladder, urethra
3 main functions of the urinary system
- removal of waste from body fluids
- elimination of waste into the environment
- homeostatic regulation of blood plasma
The medial side of the kidney where the vessels and nerves after and leave is referred to as the …
Hilum
What does the renal fascia do
Anchors the kidney to the abdominal wall
Outer layer of the kidney is called?
Renal cortex (shell)
Middle layer of the kidney is called the…
and contains cone shaped structures called…
Renal medulla
renal pyramids
What is the renal pelvis
a cone shaped collecting are that connects the ureters to the kidney
Minor calyx
drains urine from the renal medulla to the major calyx
Major calyx
drains urine from the minor calyx to the renal pelvis
How much of the cardiac output flows through the kidney every minute?
25%
The afferent artery enters the kidney and becomes what structure
The glomerulus (the main filter)
The efferent arteriole forms after leaving the glomerulus and becomes …
peritubular capillaries that permit reabsorption from the convoluted tubules
What is unique about the capillary beds in the kidney
No other organ in the body has 2 distinct capillary beds
What are the structural and functional units of the kidney and where are they found
The nephrons
In the cortex and medulla
Another name for the glomerulus capsule
Bowmans capsule
What is the path that they kidney filtrate takes from the bowman capsule to the collecting ducts
PCT - Loop of Henle - DCT
How many nephrons are contained in the kidney
1.25 million
What is the function of the podocytes
They wrap around the glomerular capillaries and form slits that permit filtrate to pass into the glomerular capsule, but are small enough to prevent larger molecules such as protein from leaving the blood stream
What is the glomerular filtration rate for a normal adult
125ml/min
What does the initial filtrate in the bowman capsule contain
glucose, salts, mineral, water and metabolic wastes
Where does initial reabsorption occur
PCT and deposited into surrounding interstitial fluid
As the interstitial fluid becomes more concentrated what happens next?
Water moves from the filtrate by osmosis into the interstitial fluid. The interstitial fluid then moves into the peritubular capillaries to restore homeostatic balance
What happens in the descending portion of the loop of henle?
It is permeable to water but impermeable to Na+ and Cl-
What is the permeability of the ascending loop of henle?
Permeable to Na+ and Cl- but impermeable to H20
After leaving the loop of henle and entering the DCT how much of the initial filtrate has been reabsorbed
85% of the water
80% of the solutes depending upon the bodies needs
What is the structure at site where the efferent arteriole and the DCT meet?
Juxtaglomerular apparatus
What do the pressure sensitive cells in the juxtaglomerular apparatus do?
release Renin in response to low BP
What are the macula dense cells sensitive to?
Sensitive to chemical changes and monitor the filtrate concentration in the DCT
What does Renin do?
converts plasma protein angiotensinogen into angiotensin I
What does angiotensin I do?
Nothing
When angiotensin I is converted into angiotensin II what does it do?
Acts as a smooth muscle constrictor (alpha 1 agonist) to increase BP and peripheral resistance and increases Na+ reabsorption in the PCT which increases water reabsorption and BP
What does ADH do and where is it produced?
Antidiuretic hormone produced by the hypothalamus is released into the blood stream in response to increases in plasma solute concentration. ADH signals the DCT to become more permeable to water and thus decreasing blood solute concentration and increasing BP
What does aldosterone do?
Increases the active rate of reabsorption of Na+ and Cl- in the blood which leads to an increase in water reabsorption
It also decreases K+ reabsorption which causes excess K+ to be excreted in the urine
Male urethra is dived into what 3 regions?
prostatic urethra
membranous urethra
spongy or penile urethra
Once urine enters the collecting ducts, what is its path out of the kidney?
minor calyx - major calyx - renal pelvis - ureters
Most of the bladder is located in the _________, with the dome of the bladder in the _______
anterior abdominal cavity
retroperitoneum
A spinal reflex that causes contraction of the bladders smooth muscle
micturition reflex
Name a few reasons for urological pain
bacteria or viral infections, kidney stones and prostate enlargement, renal failure
Name the 9 abdominal regions
R/L hypochondrial / Epigastric
R/L Lumbar / Umbilical
R/L Iliac / Hypogastric
6 causes of urinary retention
- Renal Calculi
- Acute Renal Failure
- Urethral Obstructions
- Benign Prostate Hypertophy
- UTI
- Nerve Damage
The type of pain most commonly associated with urologic problems caused by stimulation of the nerve receptors in hollow organs
Visceral Pain
Classic S&Sy of UTI
Urinary Triad Painful urination Frequent urges to urinate Difficult urination \_\_\_\_\_\_\_\_\_\_\_\_\_ Fever AMS
Where may a patient with a bladder condition experience referred pain
the neck and shoulder
If a UTI move proximal it could result in…
pyelonephritis
2 categories of urinary incontinence
Urge- sudden, intense, involuntary urge due to parkinsons, uti, stroke, CNS disorders
Overflow - constant slow flow of urine due to damaged bladder, blocked urethra or nerve damage
Where do kidney stones originate?
Renal pelvis when an excess of insoluble salts crystallize
3 types of kidney stones
Calcium (most common), Struvite (common in women), Uric acid
Migration of pain with kidney stones
Starts in the flank and migrates downward to the front
Treatments for kidney stones
hydration of 2-3 L H2o/day
Lithrotripsy
Direct Endoscopy
What is Acute Renal Failure (ARF)
Sudden decrease in filtration through the glomeruli causing toxins to accumulate in the blood
The name for urine output of less than 500ml/day
Oliguria
Anuria
Complete cessation of urine
S&Sy of ARF
generalized edema, acidosis, heart failure, hypertension
3 classifications of ARF
Prerenal
Intrarenal
Postrenal
S&Sy of Prerenal failure
Caused by hypo perfusion of the kidneys Hypotension Tachycardia Dizziness Thirst
S&Sy of Intrarenal failure
Flank Px Joint Px Oliguria Hypertension Confusion Seizure
S&Sy of Postrenal failure
Caused by blockage of flow from the kidney Px in flank and lower abdomen Oliguria Distended Bladder Hematuria Peripheral edema
Most common cause of Prerenal ARF
Hypovolemia due to CHF, trauma, shock, sepsis
Intrarenal failure is often due to what disease process?
Diabetes
What is the condition called that is characterized by the permanent loss of nephrons and scarring in the kidney
Chronic Renal Failure
CRF
CRF leads to Uremia and Azotemia, what are they?
Uremia - increased concentration of uria and other wastes
Azotemia - increased concentration of nitrogenous wastes
Patients with CRF can present with what S&Sy
ALOC Hypotension Tachycardia Pericarditis Pulmonary Edema
End stage renal disease presents with what S&Sy
Confusion SOB Peripheral edema Bruising CPx Seizures Muscle twitching Pruritis
What are the 2 types of renal dialysis
Peritoneal dialysis - large amounts of fluid are infused into the abdomen allowing for diffusion to occur and then removed from the abdomen allowing waste to leave the body
Hemodialysis - blood is circulated through a machine and is cleaned in much the same way as the kidneys function
Describe an internal shunt
a fistula (artificial connection between an artery and a vein usually located in an upper extremity. Should only be accessed in a life threatening emergency
What is epididymitis?
An infection that causes inflammation of the epididymis along the posterior boarder of the testies
What is orchitis?
When one or more of the testes become infected leading to increased tenderness and enlargement of the scrotum
What is Fournier Gangrene?
Bacteria that enters the scrotum due to a laceration and causes necrosis of the tissue
What is a priapism?
Painful, tender, persistent erection due to tumors, leukemia, spinal cord injury, cocaine or ED drugs
What is phimosis?
The inability to retract the distal foreskin over the penis
What is Paraphimosis?
Results when the foreskin is retracted over the glans penis and becomes entrapped
What is benign prostate hypertrophy?
Noncancerous enlargement of the prostate gland typically in men over 60
What is testicular torsion?
Twisting of the testicle on the spermatic cord
