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PRIN > PRIN 10 Body Fluids > Flashcards

PRIN 10 Body Fluids Flashcards

1
Q

Normal Body Water

Male vs Female

A

MALES: 60%
FEMALES: 50%

difference due to fat

NOTE: depends on physique and age

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2
Q

Normal Body Water
What is the affect of aging?
Newborn vs Elderly?

A

we gradually lose water percentage as we age

“newborns are more water and less substance
elderly are less water and more substance”

Newborns are 80% water!

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3
Q

Which organs have the highest percentage of water?

top 3

A

All have 80% water

(1) Kidney
(2) Heart
(3) Lung

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4
Q

Compartments of Body and Difference in Water Composition

A

TOTAL BODY WATER = 60%

40% ICF
20% ECF
5% plasma, 15% ISF

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5
Q

What is ISF?

A

Interstitial Fluid =

Fluid (water) outside of cells: includes Lymphatics and Transcellular Fluid

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6
Q

What is Transcellular Fluid?

A

CSF, synovial fluid, pericardial fluid, pleural fluid etc …

WE IGNORE IT (so small … unless pathology)

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7
Q

What is ICF?

A

Intracellular Fluid

  • fluid inside cells
  • all cells including blood cells
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8
Q

Which organs have the lowest percentage of water?

A 
Skeleton (20%)
Adipose Tissue (10%)
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9
Q

How can measurements of the various fluid compartments be done?

A

Indicator Dilution Method

TBW: D20 & Antiypyrine
ECF: Inulin & Na+*
Plasma Vol: Albumin* or Evans blue dye

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10
Q

Composition of ICF`

Cations & Anions …?

A

plasma water, proteins, lipids

Cation: K+
Attendant Anions: proteins, organic phosphates, acids

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11
Q

Composition of Plasma

Cations & Anions …?

A

Cation: Na+

Attendant Anions: Cl- & HCO3-

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12
Q

Equation for calculating Blood Vol

A

BV = Plasma Volume / 1-hematocrit

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13
Q

Which is the correct term to use?

Osmolarity or Osmolality?

A

Osmolality
since the volume of water can be affected by
changes in temperature

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14
Q

What is the eq/mol of Ca2+

A

2

two charges

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15
Q

What is the osmol/mol of Ca2+

A

1

only 1 species

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16
Q

What is the eq/mol of CaCl2?

A

4

four charges

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17
Q

What is the osmol/mol of CaCl2?

A

3

three species when dissociated

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18
Q

Formula for Osmotic Pressure:

A

van’t Hoff’s Law
Osmotic Pressure = nRTCk

C = [total solute] expressed in osmoles; the # of dissociated particles
k=osmotic constant

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19
Q

What is Plasma Water?

A

the volume of plasma that is associated only with the water and not the dissolved solutes
[Plasma Water] = [Plasma] / 0.93

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20
Q

Composition of ISF

Cations & Anions …?

A

Similar to Plasma, but hardly any proteins

Cation: Na+
Attendant Anions: proteins, organic phosphates, acids

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21
Q

What is the normal Osmolality of Body Fluids?

A

280 to 300 mosmol/kg water

Hyperosmotic >300
Hypo-osmotic <300

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22
Q

What IS Osmolality?

A

total number of osmotically active particles (all solutes) dissolved in water (solvent)

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23
Q

What are the major sources of water input?

MOST to LEAST

A

Drinking
Food
Oxidation of Food

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24
Q

What are the major sources of water output?

MOST to LEAST

A

Urine
Insensible Loss
Sweat
Feces

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25
Q

What are Starling’s Forces?

A

forces that determine the direction of fluid exchange across a membrane
Pc - cap. hydrostatic pressure

Pi - interstitial hydrostatic pressure

πc - capillary oncotic (colloidal osmotic) pressure; mainly exerted by proteins

πi - interstitial oncotic pressure (usually very small)

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26
Q

What is Oncotic Pressure?

A

“colloid osmotic pressure”

form of osmotic pressure exerted by proteins in a blood vessel’s plasma (blood/liquid)

pulls water into the circulatory system

opposite to hydrostatic pressure

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27
Q

What is the formula for Starling’s Forces?

Jv = ?

A

Jv = Kf x (Pc - P i- πc + πi)

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28
Q

What does the value of Jv indicate?

A

A POSITIVE Jv value indicates that water is forced out of the capillaries and into the ISF

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29
Q

Three Functions of Kidney

A

(1) Regulatory
(2) Endocrine
(3) Excretion

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30
Q

Three Functions of Kidney

(1) Regulatory … How?

A

(i) Ionic Composition
(ii) pH
(iii) Body Fluid Vol.
(iv) Long term regulation of BP

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31
Q

How do we calculate BP?

A

BP = CO x TPR

CO = cardiac output
TPR = total peripheral resis.
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32
Q

Three Functions of Kidney

(2) Endocrine … How?

A

(i) Erythropoietin
(ii) Activation of Vit D
(iii) Production & Release of Vasoactive substances (RAS, kinins, prostaglandins)

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33
Q

What is RAS?

A

Renin-Angiotensin System:

**Angiotensinogen
converted by RENIN (gen in kidney) to ...
**Angiotensin I (AI)
converted by ACE (gen in lungs) to
**Angiotensin II (AII)
(potent vasoconstrictor)
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34
Q

What will high blood pressure medications target?

A

act to block ACE
prevents conversion of AI to AII
(Angiotensin Converting Enzyme)

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35
Q

What are kinins & prostaglandins?

A

Vasoactive substances produced & secreted by kidney

VASODILATORS

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36
Q

Three Functions of Kidney

(3) Excretion … How?

A

(i) Formation of Urine
(Micturition)
(ii) Elimination of Waste Products
(urea, uric acid, creatinine)

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37
Q

What does the Renal Corpuscle consist of?

A

Renal Corp = Bowman’s Capsule + Glomerulus

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38
Q

Short vs Long Loop Nephrons

What are the names?

A

**Cortical Nephron
(short loop - does not penetrate inner medulla)
(no Asc. Thin Limb)

**Juxtamedullary Nephron
(long loop - penetrates the inner medulla)
(has an Asc thin limb)

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39
Q

Regions of Nephron

A

PCT: Prox Convoluted Tubule
PST: Prox Straight Tubule

DTL: Desc Thin Limb
ATL: Asc. Thin Limb *(juxtamedullary nephron only)
TAL: Thick Ascending Limb

DCT: Distal Convoluted Tubule
CNT: Connecting Duct

CCD: Corticol Collecting Duct
MCD: Medullary Collecting Duct
OMCD: Outer Medullary CD
IMCD: Inner Medullary CD

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40
Q

What is GFR?

A

Glomerular Filtration Rate

*the volume of blood being filtered per unit of time (ml/min)

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41
Q

From external to internal of the glomerular capillaries, what are the membrane structures?

A

Podocytes
Pedicles
Fenestra - windows/pores

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42
Q

What substances pass freely through the glomerular membrane?

A

Radii of less than 15A
MW neutral>anions

(positive ions travel through easier because the membrane is negatively charged due to proteins)

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43
Q

By what methods can Clearance Values be attained?

A

Renal Plasma Flow
*clearance of Para-amino-hippuric acid

Glomerular Filtration Rate
Clearance of inulin

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44
Q

How is Clearance calculated?

A

Cx = UxV / Px

C = Clearance (ml/min)
Ux = Urinary [X] (mg/ml)
Px = Plasma [X] (mg/ml)
V = urinary flow rate (ml/min)
UxV = urinary excretory rate of X (mg/min)
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45
Q

Methods for Estimation of GFR

A

(1) Clearance of Inulin or Creatine
(2) Serum / Plasma Creatinine Conc.
(3) Cockcroft-Gault Formula
(4) Starling Forces

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46
Q

Mechanisms involved in the maintenance of GFR

A

(1) Myogenic
via smooth muscle
Blood Flow = Change in Pressure / Change in Resistance

(2) Tubuloglomerular Feedback (TGF)
via Juxtaglomerular App.

47
Q

What is the JGA composed of?

A

Juxtaglomerular Apparatus

1) macula densa cells
(2) Granular cells (renin producing
(3) extraglomerular mesangial cells (Lacis Cells)

48
Q

What happens in response to increase in GFR?

A

Macula densa cells sense an increase in Na and send out a signal via adenosine & ATP

49
Q

What happens in response to decrease in GFR?

A

Macula densa cells sense a decrease in Na

send out a signal via NO, prostaglandins, and LESS purines (adenosine & ATP)

50
Q

How much Na is actually excreted?

A

Less than 1%. It is essentially all reabsorbed

51
Q

Where is the nephron impermeable to Na?

A

Descending Thin Limb

52
Q

What hormones are involved in the re-absorption of Na?

Where do they act?

A

ANGIOTENSIN II, NE, E
Proximal Tubule

ALDOSTERONE
*Distal Tubule

53
Q

What is Fractional Excretion?

Formula?

A

the fraction of filtered load that is being excreted by the kidney

FE = (UV)/(PxGFR)

54
Q

What is Fracitonal Reabsorption?

A

1-FE

55
Q

Where does water reabsorption occur?

A

PT - 66%
small amounts are absorbed elsewhere
BUT, water is NOT absorbed in ATL & TAL

56
Q

Na & Water

Where does each one NOT get reabsoribed?

A

Na+ does not get reabsorbed in the DTL

Water does not get reabsorbed in the ATL or TAL

57
Q

What is AVP?

A

Arginine vasopressin

aka “ADH” for its function as an antidiuretic

58
Q

Where does AVP act?

A

late DT and CT

upregulates AQP-2 (apical
aquaporins)

59
Q

Where do specific aquaporins act?

A

AQP-1 acts on:
Proximal Straight Tubule (PST)
Desc. Thin Limb (DTL)

AQP-2(apical), 3 & 4(basal) act on the CCD & CD

60
Q

Where is the control center for ADH synthesis?

A

Paraventricular Nucleus

Supraoptic Nucleus

61
Q

Where does ADH synthesis actually occur?

Where is secreted from?

A

ADH synthesis in Magnocellular neurons / Magnocellular Neurosecretory Cells

Secreted from Neurohypophysis Nerves (post. pituitary)

62
Q

How is ADH made?

A

Pre-pro-vasopressin gets cleave into sections:

Vasopressin

Neurophysin II (binding protein)

63
Q

What are possible explanations for the faulty vasopressin?

A

(1) defective vasopressin, OR

(2) defective Neurophysin II

64
Q

When do osmoreceptors become activated?

A

Normal = 280-300
AVP is ALWAYS secreted to some degree

Above 300, AVP enhanced secretion
Below 280, AVP not enhanced

Osmotic Threshold for Thirst >289

65
Q

Where are osmoreceptors located?

A

(1) organum vasculosum lamina terminalis (OVLT)
(2) subfornical organ (SFO)
(3) median preoptic nucleus (MnPO)
(4) supraoptic nucleus (SON)

66
Q

What do baro-receptors do?

A

Sense stretch changes:

HIGH PRESSURE:

(1) aoritic arch
(2) carotid sinus
(3) JGA

LOW PRESSURES:

(1) atria
(2) veins

67
Q

What happens when decreased volume is detected?

A

Na+ Re-absorption Increased by neural & hormonal means

ANGIOTENSIN II, NE, E
Proximal Tubule

ALDOSTERONE
*Distal Tubule

68
Q

What happens when increased volume is detected?

A

Na+ Re-absorption Decreased by neural & hormonal means

Atrial Natri-uretic Peptide
-inhibits Aldosterone & AVP secretion (thereby inhibiting Na+ reabsorption)

69
Q

What is hyponatremia?

A

low Na+

70
Q

What is Polydypsia?

A

excessive thirst

71
Q

What is Polyuria?

A

excessive urination

72
Q

What is Nocturia?

A

getting up in night to pee

73
Q

Hypernatremia?
Hypercapnia?
Hyperkalemia?
Hypercalcemia?

A

natremia = Na+

capnia = CO2

kalemia = K+

calcemia = Ca2+

74
Q

ECF vs ICF

What can we measure?

A

We can only manipulate the ECF clinically and only measure changes in the ECF.

We can only infer changes in the ICF.

75
Q

What is the main role of Angiotensin 2?

A

(1) Vasoconstriction
(2) Sodium Handling via Aldosterone
(3) Stimulate Post Pit to release ADH & Stimulate Thirst

76
Q

What happens to GFR when we constrict the Afferent arteriole?

A

Reduces GFR

77
Q

What happens to GFR when we constrict the Efferent arteriole?

A

Raises GFR

78
Q

What is the effect of Angiotensin II on GFR?

A

AngII blocks the efferent more than afferent

Therefore, GFR goes up

79
Q

What is the effect of Angiotensin II inhibitor?

A

Decreases Efferent Constriction

GFR goes down

80
Q

How to diagnose DI?

A

Diabetes Inspidus

24 hr Water Restriction Test

81
Q

What are the four types of DI?

A

(1) Primary polydipsia (psychogenic)
(2) Central/Neurogenic
(3) Nephrogenic
(4) Gestational

82
Q

Central DI

Response to Water Restriction Test

A

After water restriction:
VERY dilute urine

After water restriction and treatment with Desmospressin:
Normal, concentrated urine

83
Q

Nephrogenic DI

Response to Water Restriction Test

A

After water restriction:
VERY dilute urine

After water restriction and treatment with Desmospressin:
VERY dilute urine … no change

84
Q

What causes Central DI?

A

Post. Pit does not produce AVP (ADH) due to genetic mutation in the Nerophysin portion or trauma

Therefore, these patients respond to DDAVP (desmospressin)

85
Q

What causes Nephrogenic DI?

A

Mutation gives to rise to faulty AQP gene. Normal ADH but nephron doesn’t respond to it.

Therefore, insensitive to DDAVP

86
Q

How can pregnancy result in Gestational DI?

A

Placenta releases enzyme that degrades AVP.

87
Q

General Causes of DI:

A

Injury / Trauma
Disease/Drugs
Genetic
Idiopathic (aka … nobody knows!)

88
Q

What does a bright spot on the Post. Pit indicate during an MRI?

A

Function, ADH secreting neurons

89
Q

What are the nuclei in the brain involved in AVP secretion?

A

SON: Supraoptic

PVN: Paraventricular

90
Q

Which kidney is lower?

A

Right, due to presence of liver

91
Q

Osomoreceptors vs Baroreceptors

Sensivity

A

Osmoreceptors sense change within 1-2% (very sens

Baroreceptors sense change within 10%

92
Q

What is ANP?

A

Antri Natri-uretic Peptide

Released from myocytes of the Cardia Atria
Causes vasodilation
(would get inhibited in the presence of decreased circulating volume)

93
Q

What is TGF?

A

Tubuloglomerular feedback

main job is to prevent severe loss of Na+

causes constriction of afferent artery in the presence of volume depletion

94
Q

What stimulates release of ADH?

A

Physiological factors:
osmolality, pain, nausea, fear, anxiety

Non-physiological factors:
drugs, cancer, chronic lung disease, intracranial bleeding

95
Q

How do glucose and Na+ interact?

A

fo revery 10 mmol increase in glucose, approx 3 mmol drop in Na

96
Q

What is dyspnea?

A

SOB

97
Q

What does JVP reveal?

A

Jugular Vein Pressure

when high and distended suggests high ECF volume

98
Q

How does Congestive Heart Failure affect the kidney?

A

Blood backs up, resulting in low BP. Therefore, the kidney responds by retaining sodium and water in order to raise BP back up.

99
Q

What is the effect of an ACE inhibitor?

A

Causes BP to decrease

100
Q

What abnormalities can lead to disease state of DI?

A

(1) deficiency in AVP production
(2) defect of the aquaporin II gene
(3) defect of the thirst center
(4) increased metabolic clearance of AVP

101
Q

The sensors for detecting changes in extracellular fluid volume (ECFV) and osmolality, respectively are…

A

Volume receptor

Osmoreceptor

102
Q

What happens when we eat lots of salt

A

Plasma Na increases

Osmoreceptors in the brain detect increased Na+ (organum vasculosum of the lamina terminalis (OVLT))

Triggers thirst & ADH secretion

103
Q

What are the values of U-osm at Max and Min ADH

A

1200 mosmol/kg H20 at max ADH

70 mosmol/kg H20 at min ADH.

104
Q

What are glucose levels like in DI and DM?

A

DI: normal glucose levels

DM: elevated glucose levels

105
Q

Where is renin produced?

A

granular (juxtaglomerular) cells of the afferent arterioles in the kidney

106
Q

What are the units to express osmolalitity?

A

mmol/kg

107
Q

What is the major cation and anion in ISF?

A

Na+

Cl-

108
Q

To replenish a decreased ECF volume containing an abnormally high sodium, you would choose

A

Hypertonic glucose solution

(Glucose is subsequently metabolized and leaving the water behind to dilute the high osmolality generated by the high [sodium]).

109
Q

Where are Osmoreceptors located?

A

organum vasculosum of the lamina terminalis (OVLT)

and the subfornical organ

110
Q

Renin secretion is elicited by:

A

Decrease in glomerular filtration rate

111
Q

What happens when GFR decreases?

A

Renin is secreted from the granular (juxtaglomerular) cells of the afferent arterioles in the kidney

112
Q

What is the role of Aldosterone?

A

Increase reabsorption of Na in the late DT and CD.

113
Q

What does a Negative C_H20 number mean?

A

If the value of C_H20 is negative that means water is being reabsorbed.

(positive for excretion)

114
Q

If the efferent arterioles in the glomeruli of the kidneys are constricted.

How effect renal plasma flow?
How affect GFR?

A

Renal Plasma Flow decrease

GFR will decrease

PRIN (13 decks)

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