Renal colic and hypovolaemia Flashcards by Jess Godfrey

What is the 20 40 60 rule with regards to fluid and body weight?

20% of body weight vol = ECF
40% = ICF
60% = total body water

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Give 3 examples of transcellular fluid in the body

CSF
vireous humour
synovial fluid

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What is transcellular fluid?

Fluid seperated from the plasma by the capillary endothelium which has specialised functions

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What is osmotic pressure?

Pressure at which water is drawn into solution over a semipermeable membrane

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What is osmolarity?

Total solute concentration in a solution - measured in mOsm/L

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What is osmolality?

Molar concentration of solute particles per kg of solvent - measured in mOsm/kg

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What happens to cells in a hypertonic solution?

Cells shrink as water moves across the plasma membrane to the to the more concentrated solution in the ECF

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What happens to cells in a hypotonic solution?

Cells swell as the water moves intracellularly to a more concentrated environment

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What is the main cation found intracellularly?

K⁺

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What is the main cation found extracellularly?

Na⁺

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How many sodium ions are exchanged for potassium ions by the Na/K pump?

3Na⁺’s for every 2K⁺

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Where are osmoreceptors found?

In the hypothalamus

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What is unusual about the capillaries adjacent to the osmoreceptors of the hypothalamus?

They are pearmeable unlike the rest of the BBB

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What effect does ADH have on the distal collecting tubules in the kidney?

Makes them more permeable so that further resorption of water can happen

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What effect does ADH have on the osmolality of blood?

Increases

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Which electrolyte concentration in the blood determines the extracellular fluid volume?

Sodium

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What is a colloid?

(give 2 e.g’s)

Solutions containing small solutes given IV which remain in the circulation for under an hour.

5% dextrose
Hartmann’s
0.9%NaCl

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What are colloids?

(give 2 e.g’s)

Fluid containing a substance microscopically dispersed throughout. Remains in the circulation for hours/days.

gelatin polymers
hyoxywthyl starch
human albumin
blood

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What is the range of normal serum levels of sodium?

135-145mol/L

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What is the normal range for serum potassium?

3.5-5mol/L

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What is the normal range for serum creatinine?

70-150 μmol/L

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What is the normal range for serum urea?

2.5-6.7 mmol/L

What could high creatinine and high urea signify?

Possible dehydration

What are nuclear medicine studies useful for when looking at the kidneys?

To check function e.g. pre transplant

Which part of the adrenal gland secretes: * mineralocorticoids * glucocorticoids * sex hormones

Cortex

Which part of the adrenals secrete chatecholamines?

Medulla

Name 4 types of shock

* cardiogenic * hypovolaemic * obstructive * maldistributive

Why does the skin feel cold and clammy in shock?

Increased resistance to blood flow to restore arterial pressure - redistribution of CO to the brain and heart and away from the peripheries

What is the definition of DIC?

Pathological widespread activation of blood coagulation coupled with inappropriate haemorrhage due to the release of procoagulants

Where are the 3 constrictions of the ureters?

1. uteropelvic junction = anatomical constriction 2. pelvic inlet = crossing the common iliac vessels 3. entrance to the bladder

What is the median umbilical ligament?

Remnant of the allantois - connects the apex of the bladder with the umbilicus

What does the internal urethral sphincter prevent in men?

Retrograde flow of semen into the bladder during ejaculation

Where do the parasympathetic preganglionic fibers come from to innervate the bladder?

Pelvic splanchnic nerves = S2 S3 S4

What are the pubovesicle and puboprostatic ligaments?

Fibromuscular bands which suspend the neck of the bladder in women. FIbers blend into the prostate in men

Why isn't ascites associated with kidney injury?

Kidneys are retroperitoneal

What is the trigone?

Smooth triangular portion of the internal part of the bladder connecting the ureters and the urethra

Which adrenal is crescent shaped?

Left

Name a type of benign kidney tumour

Oncocytoma

Which type of haematuria is most commonly seen in renal colic?

Microscopic

Which tissue does renal cell carcinoma derive from?

Proximal tubular epithelium in the upper poles of the kidneys

What is Von Hippel Lindau syndrome? Which chromosome is it associated with?

* AD condition which pre-disposes individuals to benign and malignant tumours (RCC) * Chromosome 3

Which condition is associated with mutations in the proto-oncogene on chromosome 7?

Hereditory papillary RCC

What makes up the most common type of kindey stone?

Calcium oxylate

Where are the most common sites for stones to become lodged?

Wherever there is constriction of the ureters: * pelviureteric junction * arch over the iliac vessels * vesicoureteric junction * opening of the bladder

What is desmopressin used for?

When treating urolithiasis - also reduces urine production

When is nifedipine used in kidney conditions?

When helping the passage of stones

Where is ADH secreted from?

Pituitary gland

What kind of fluid loss is diarrhoea? 1. hyperosmotic contraction 2. hypoosmotic contraction 3. isosmotic contraction

3. - isosmotic contraction. ## Footnote There is a decrease in ECF but not in its osmolarity

What kind of fluid loss is seen in SIADH? 1. isosmotic expansion 2. hyposmotic expansion 3. hyposmotic contraction

2. - hyposmotic expansion ## Footnote Hyponatraemia leading to excess water retention. Water--\> into cells which increases the intracellular volume

The loop of Henle is permeable to H₂O but not to...?

Na⁺ - meaning resorption of H₂O back into the circulation

Describe how the SNS regulates blood volume

* SNS innervated the juxtaglomerular cells which sense stretch of the afferent arterioles * less stretch when there's decreased ECF volume + decreased mean arterial pressure * this is picked up in the carotid baroreceptors * they initiate renin secretion

What are the mechanism for resolution of non-progressive stages of shock?

1. fast = reflex controlled (baroreceptors and chemoreceptors) 2. Intermediate = hormonal control (ADH, RAAS, Glucagon) 3. Long-term recovery i.e. increased of blood volume, plasma proteins and red cell mass over time (6/52)

What is 'sick cell syndrome'?

* Na⁺/K⁺ pump not working * cells swell due to uptake of water * dangerous in the CNS