Physiology-McCormick Flashcards by Kelley Perry

Which cations and anions predominate IC?

K: IC=140, EC=4-4.2

Mg: IC=20

Phosphate: IC=11

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Diarrhea/hemorrhage, water deprivation/dehydration, and diuretics/adrenal insufficiency have what effect on volume in a darrow-yanet?

Volume contraction

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Infusion of isotonic NaCl, high NaCl intake, and SIADH have what effect on volume in a darrow yanet diagram?

Volume expansion

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Distribution of fluid between the ECF and ICF is determined primarily by:

Ion distribution (Na)
ATPase activity

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Distribution of ECF between the plasma (vascular space) and interstitial (tissue) compartments is determined by:

Balance of hydrostatic vs oncotic pressures

Intravascular pressure in capillaries vs plasma protein and solute concentration

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___ is swollen cells due to increased ICF volume..does NOT respond to diurectics

Non-pitting edema

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___ is increased interstitial volume…nephrotic syndrome, CHF, pregnancy, cirrhosis

Pitting edema

Can respond to diuretics

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These cells are within the afferent arteriole and cause renin secretion

Granular cells

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___ are from the sacral micturition center S2-S4 (pelvic nerve) and stimulate detrusor muscle and inhibits contraction of internal urethral sphincter

Parasympathetic fibers (cholinergic-Ach)

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___ inhibits detrusor constriction, constricts internal urethral sphincter

Sympathetic fibers (adrenergic-NE)

Hypogastric n.

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__ are voluntary and constrict the external urethral sphincter

Somatic motor neurons

Pudendal n.

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Which cations and anions predominate in the EC?

Na: plasma=142, interstitial=139, IC=14

Cl: Plasma and interstitial=108, IC=4

HCO3: plasma=24, interstitial=28.3, IC=10

Ca: EC=1.3, IC=0

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What is the equation for GFR?

GFR=Kf x Puf

Kf-ultrafiltration coefficient

Puf-Capillary ultrafiltration pressure

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How do you calculate the ultrafiltration pressure?

Puf=Pgc - (Pbc + piGC)

Pgc-glomerular capillary pressure

Pbc-bowmans capsule pressure

piGC-oncotic pressure in bowmans capsule

This is the net filtration pressure and bowmans capsule oncotic pressure is zero so not needed in calculation

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Contraction of __ cells shortens capillary loops, lowers Kf, and, thus lowers GFR

Mesangial

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Describe what happens to the following when you have afferent arteriole constriction:

Greater pressure ___ upstream of glomerular capillaries
Pgc will ___, which lowers GFR
Renal blood flow ___ due to increased resistance

Drop

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Describe what happens to the following when you have efferent arteriole constriction:

Pooling of blood in the ___
___ Pgc will increase GFR
Renal blood flow will ___

Glomerular capillaries

Increased

Decrease

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Describe what happens to Pgc, RBF, and GFR when you have increased systemic arterial pressure:

They all increase

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Describe what happens to Pgc, RBF, and GFR when you constrict the afferent arteriole

They all go down

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Describe what happens to Pgc, RBF, and GFR when you have moderate efferent arteriolar constriction

Increased Pgc

Decreased RBF

Increased GFR

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What is the equation for Clearance?

Cx= Ux x V / Px

Cx-Clearance of x

Ux-Concentration of x in urine

V-Urine volume

Px-Concentration of X in plasma

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As creatinine goes up, what happens to GFR?

Goes down

Pcreatinine is inversely proportional to GFR–> useful for long-term monitoring of renal function

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What is the equation for filtration fraction?

FF=GFR/RPF

Normally, approximately 20%

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In renal artery stenosis, what happens to FF?

Increased–> decrease the denominator

FF=GFR/RPF

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What is the equation for filtered load?

Filtered load of x=GFR x Px

If excretion is less than filtration, net __ occured If excretion is greater than filtration, net __ occurred

Reabsorption Secretion

The PCT reabsorbs most of filtered ___ Several organic anions and cations (drugs, drug metabolites, creatinine, urate) are secreted in the ___

Water, Na, K, Cl, bicard, Ca, P. Reabsorbs all of filtered glucose PCT

Proximal tubular __ reabsorption provides the driving force for reabsorption of water, other solutes.

Where is the Na/K ATPase?

Basolateral membrane

Where does Na cotransport with glucose, AA's, phosphate, and Na countertransport with H+ occur?

PCT

Where does Na/K/2Cl occur?

Thick ascending limb

Where does Na/Cl cotransport occur?

Early DCT

__ are a new class of oral antihyperglycemic agents which lower the Tmax for glucose excretion

SLGT-2 Side effects include UTIs and increase in the osmolarity in the tubule system due to excess glucose can lead to dehyrdration due to osmotic diuresis

___ inhibits proximal tubular phosphate reabsorption

PTH This effect of PTH increases the amount of P excreted at any given plasma P concentration

Overdose of an organic acid (acetylsalicylate or aspirin) may be treated by ___ of urine through HCO3 administration which promotes urinary excretion by trapping the acid in tubular lumen

Alkalinization

This portion is freely permeable to water and impermeable to Na and Cl

Desc limb of henle

This portion is always impermeable to water

Asc limb of henle

This portion of the ascending limb does NaCl reabsorption

Thin

This part of the asc limb of henle has an active Na/K/2Cl cotransporter

Thick segment

__ is the major site of physiological control of salt and water balance

Late DCT and CD

__ stimulate Na reabsorption, K secretion, and H secretion in the late DCT and CD

Aldosterone

Aldosterone acts primarily on these cells in CD

Principal cells

What conditions can drive K out of the ICF and into ECF?

Hypokalemia and Acidemia

What conditions can push K from the ECF into the ICF?

Hyperkalemia B-adrenergic agonists (epi) INSULIN

__ is freely filtered into bowmans capsule, 67% reabsorbed in PCT, 20% reabsorbed in thick AL of henle, and physiological control is exerted in the CD

__ cells either reabsorb or secrete K, depending on body's K balance

Principal

___ stimulates K secretion in CD to maintain electroneutrality when Na is reabsorbed

Aldosterone

In a low-sodium diet, you get less __ delivery to the late distal tubule, the collecting duct will have less K secretion and excretion which can cause ___

Na Hyperkalemia HyperK can be treated by increasing downstream delivery of Na to distal tubules/CDs

How does Mg paracelluarly diffuse in the thick AL?

K leak channels create a positive charge in the tubule which sets up a gradient to paracellularly transport

___ increases water and urea permeability of late DCT and CD

ADH

Describe water permeability of CD in a well-hydrated pt:

Water remains in tubular lumen; dilute urine is excreted LOW ADH

Describe water permeability in a dehydrated pt:

CD is highly water-permeable, water is reabsorbed, low volume of concentrated urine is excreted HIGH ADH

___ promotes urea reabsorption from inner medullary CD by increasing expression of urea transporters

ADH

Describe the urine volume and concentration in dehydration and SIADH?

Low volume, highly concentrated High ADH

Describe the urine volume and concentration in diabetes insipidus and volume expansion

High volume of dilute urine is excreted Low ADH

__ increases Na and water excretion by increasing GFR, inhibiting Na reabsorption in medullary CD, suppressing renin secretion, suppressing aldosterone secretion, it is a systemic vasodilator, and suppresses AVP secretion

ANP

How do you calculate Free Water clearance?

CH2O=V - Cosm

If Uosm is less than Posm, CH2O is positive and pure water is ___

Cleared from the body

If Uosm > Posm, CH2O is negative, pure water is ___

Retained

How do you calculate Fractional Excretion of Na?

UNa x PCr / PNa x UCr

What does a FENa below 1% suggest? What does a FENa above 2% suggest?

Below 1%-prerenal and AGN-Na avidly reabsorbed Greater than 2%-ATN, renal-Tubular damage disrupts normal Na reabsorption

In acidemia, increased H has what effect on Ca?

Increased free plasma [Ca] H displaces Ca from plasma proteins Acidemic pts tend to have hyperkalemia

Acidosis has what effect on EC potassium?

Hyperkalemia

How do you calculate anion gap? What is the normal range for anion gap?

Cations - anions Na - (Cl + HCO3) Normal range= 8-11 mEq/L

What are causes of high anion gap acidosis?

``` Methanol Uremia DKA Propylene glycol Isoniazid Lactic acidosis Ethylene glycol Salicylates ``` MUDPILES

Physiology-McCormick Flashcards

(65 cards)