urinary system Flashcards
1
Q
what are the functions of the urinary system (8)
A
excretes waste in urine
regulate blood volume
regulate blood composition
regulates BP
regulates blood pH
regulate blood glucose levels
produces calcitriol
produces erythropoietin
2
Q
what are 4 metabolic waste products
A
urea, creatinine, uric acid, bilirubin
3
Q
what is urea
A
breakdown of amino acids
4
Q
what is creatinine
A
breakdown of creatine phosphate in muscles
5
Q
what is uric acid
A
catabolism of nucleic acids
6
Q
what is bilirubin
A
catabolism of hemoglobin
7
Q
what is catabolism
A
the breakdown of larger moleculse into smaller, to produce energy
8
Q
through what chemical ions do the kidneys regulate blood composition
A
sodium, potassium, calcium, chloride, and phosphate ions
9
Q
what are the 2 types of blood acidosis
A
metabolic acidosis - kidneys not functioning enough
respiratory acidosis - not enough CO2 being blown out
10
Q
which electrolyte is in the intracellular fluid
A
potassium
11
Q
which electrolyte is in the extracellular fluid
A
sodium
12
Q
what (3) electrolytes are responsible for bone health
A
calcium
magnesium
phosphate
13
Q
which kidney is more inferior
why
A
the right
because of the liver
14
Q
at which angle are the kidneys
A
obliqued 30 degrees anteriorly
15
Q
at what vertebral level are the kidneys
A
T12 - L3
16
Q
which end (sup/inf) of the kidney is more posterior?
A
the superior end is more posterior
17
Q
which ribs partially protect the kidneys?
A
11 and 12
18
Q
where do the ureters enter the bladder
A
through the floor, close to the midline
19
Q
where is the renal hilum directed
A
30 degrees from the coronal plane
towards the aorta
20
Q
what does an RPO 30 degrees oblique best demonstrate
A
the left kidney
21
Q
how does RPO 30 deg oblique demonstrate the right kidney?
A
in profile
22
Q
what is 1
A
the right kidney
23
Q
what is 2
A
the left kidney
24
Q
what is 3
A
ascending colon
25
what is 4
descending colon
26
what is 5
the abdominal aorta
27
what is 6
the inferior vena cava
28
what structures are anterior to the right kidney (4)
right lobe of liver
descending duodenum
hepatic flexure
ascending colon
29
what structures are anterior to the left kidney (4)
tail of pancreas
stomach
splenic flexure
descending colon
30
where (peri wise) are the kidneys
retroperitoneal
31
what are the 2 capsules around the kidney
renal capsule
adipose capsule
32
what is the innermost capsule of the kidneys
renal capsule
33
what does the adipose capsule do
protect
hold kidneys in place
34
what is nephron ptosis
the dropping of the kidneys from supine to erect
35
what body type would have the greatest amount of nephro-ptosis
asthenic
(has the least fat)
36
what is the outermost capsule of the kidneys
the renal fascia
37
what does the renal fascia do
connect kidney to
abdominal wall, lumbar vertebrae, and diaphragm
38
to what extent do the kidneys experience respiratory excursion from full inspiration to full expiration **
up one inch
39
does the renal cortex include the renal columns
yes!!
40
what do the renal columns do
anchor the renal cortex
41
which is the outer layer of the kidneys
the renal cortex
42
how many renal pyramids is typical
8-18 renal pyramids
43
what is the renal medulla
the inner layer of the kidneys
8-18 pyramids, renal papilla
44
how many minor calyces does a person have (per kidney)
8-18
the same number as that of pyramids
45
at what point is filtrate considered urine? why?
at the minor calyces
the concentration can no longer change
46
how many major calyces is typical (per kidney)
2-3
47
what is the drainage order of the kidneys
pyramids (in medulla)
minor calyces
major calyces
renal pelvis
ureter
48
what type of arteries run through the renal columns
interlobar arteries
49
give numbers for the structures following the flow of urine
minor calyces (8-18)
major calyces (2-3)
renal pelvis (1)
ureter (1)
50
why is the right kidney so dark
not picking up contrast (dark)
therefore no filtration happening
therefore pathology present
51
what is the functional unit of the kidney
the nephron
52
how many nephrons are in each kidney
1 million
52
where are nephrons located
in the renal cortex and renal medulla (pyramid) of the kidneys
53
what are the 2 parts of the nephrons
renal corpuscle
renal tubule
54
what is the renal corpuscle
responsible for actually filtering the blood
55
what are the 2 parts of the renal corpuscle
glomerulus
bowmans capsule
56
what is the glomerulus
a network of capillaries in the renal corpuscle
57
what is the Bowman's/glomerular capsule
a double walled cup in the renal corpuscle
58
where is the filtration taking place
in the renal corpuscle
59
what are the 3 parts of the renal tubule
proximal convoluted tubule
loop of Henle (nephron loop)
distal convoluted tubule
60
how much of the resting cardiac output is being received by the kidneys
20-25%
61
which renal artery is longer
the right
because the abdominal aorta is to the L of the midsagittal plane
62
name the blood flow from renal arteries to nephron (6)
renal arteries
segmental arteries
interlobar arteries
arcuate arteries
cortical radiate arteries
afferent arterioles
63
how many segmental arteries does each kidney have
5
64
where do the interlobar arteries pass
through the renal columns
65
where are the arcuate arteries
the arch between the renal medulla and cortex
66
where do the cortical arteries run
radiate outwards into the renal cortex
67
what artery supplies the capillary network
glomerulus
68
what artery carries blood AWAY from the glomerulus
the efferent erterioles
69
where are the peritubular arteries
surrounding the tubular parts of the nephron
70
what is the different between the afferent and efferent arteries
the afferent arteries are BIGGER
71
what are the 2 types of nephrons
cortical and juxtamedullary
72
what percentage of nephrons are cortical nephrons
80-85%
73
what percentage of nephrons are juxtamedullary
15-20%
74
what is the difference between cortical and juxtamedullary nephrons
cortical - renal corpuscles in outer part of cortex
short loop of henle
juxtamedullary - renal corpuscles lie deep in the cortex
long loop of henle
75
why is the glomerulus "leaky"
large fenestrations (pores)
allows solutes to leak out, but NOT BLOOD CELLS
76
what are the layers of the Bowman's casule
visceral (inner) layer
parietal layer
77
where is filtrate collected
in the capsular space of the Bowman's capsule
78
what is between the PCT and DCT
loop of henle
79
what are the 2 parts of the loop of henle
descending and ascending loops
79
what 2 cell types does DCT have
principal cells
intercalated cells
80
what are principal cells
receptors for ADH and aldosterone
81
what are intercalated cells for
homeostasis of blood pH
82
what are the 3 steps to renal physiology
glomerular filtration
tubular reapsorption
tubular secretion
83
what is glomerular filtration
in the mlomerulus, blood plasma and dissolved substances get filtered INTO the glomerular capsule
84
what is tubular reabsoprtion
along the renal tubule, substances get reabsorbed back into the blood
85
what is tubular secretion
any substances left (waste) in the tubule make their way into the urine
86
why is the volume of fluid filtered in glomerular filtration so great
large surface area
thin porous filtration membrane (0.1mm thick)
high glomerular blood pressure
87
why is the glomerular blood pressure so high
afferent arteriole is larger than the efferent arteriole
88
what is GBHP
glomerular blood hydrostatic pressure
89
what is CHP
capsular hydrostatic pressure
90
what is BCOP
blood colloid osmotic pressure
91
what is hydrostatic pressure
pushes fluid OUT
92
what is osmotic pressure
pulls fluid IN
93
what does GBHP do
promotes filtration (pushes fluid from blood to Bowman's capsule
94
what does CHP do
back pressure from fluid already in bowmans capsule
95
what does BCOP do
pulls fluid back into the blood
96
how strong is GBHP
55 mmhg
97
how strong is CHP
15 mmhg
98
how strong is BCOP
30 mmhg
99
NFP = ? (formula)
NFP = GBHP - CHP - BCOP
100
what is the average NFP
10 mmhg
101
what happens if GBHP passes below 45
no filtration occurs (NFP is 0)
102
what happens to the NFP when the afferent arteriole dilates
greater NFP
103
what happens to the NFP when the efferent arteriole dilates
lesser NFP
104
what is GFR word and desc
glomerular filtration rate
= the amount of filtrate formed by both kidneys each minute
105
what is used to measure how well the kidneys work
GFR
106
what is the average GFR for males and females
males 125mL/min
females 105mL/min
107
can you measure GFR in real life?
no EGFR is used instead
108
what things are needed to know an EGFR (4)
creatinine level (blood test)
age
gender
race (black or other)
109
GFR (increases/decreases) with age
decreases
110
what is the highest eGFR level that is great
90 or more
111
what eGFR range is needed to ask before injection
30-60
112
what level indicates renal failure (and you must be SO careful when injecting)
<30
113
what 2 things regulate GFR
1. adjusting blood flow in/out of glomerulus
2. altering glomerular capillary surface area
114
what body process requires a constant GFR
body fluid homeostasis
115
what happens when GFR fluctuates too high
may lose needed substances
116
what happens when GFR fluctuates too low
may not have enough filtration (waste products do not get excreted)
117
what 3 processes regulate GFR
renal autoregulation
neural regulation
hormonal regulation
118
what are the 2 mechanisms of renal autoregulation
myogenic mechanism
tubuloglomerular feedback
119
what is the myogenic mechanism
(normalizes GFR in seconds)
when BP rises, stretch receptors trigger constriction in the afferent arterioles
120
what does tubuloglomerular feedback do
detect increas of Na/Cl/water
inhibits nitric oxide in juxtaglomerular apparatus, constricting the afferent arterioles
121
where is the receptor for tubuloglomerular feedback
in the DCT
122
how/when does neural regulation work
emergency hemmorrhages or dehydration
constricts afferent and efferent to conserve blood for the heart and brain
123
what happens to most of the filtrate in the tubules
it is reabsorbed back into the bloodstream
124
what is the different between active and passive transport
active requires energy and passive does not
125
what percentage of water is reabsorbed
99%
126
how much urine is produced on average
1.8L (males)
127
solute reabsorption drives what
water reabsorption
128
water reabsorption happens via what
osmosis (passive)
129
what are the 2 categories of water reabsorption
+ their percentages
obligatory WRA 90%
facultative WRA 10%
130
where does obligatory WRA happen
PCT and descending loop of henle
131
does obligatory WRA require energy
no, passive
132
what does facultative mean
capable of adapting to a need
133
facultative WRA is regulated by what
ADH - antidiuretic hormone
134
where does facultative WRA happen
DCT and collecting ducts
135
what is tubular secretion
how we're getting rid of waste projects (controls pH level)
136
where does tubular secretion happen
site other than filtration membrane
PCT, DCT, collecting ducts
137
what ions are secreted in tubular secretion
hydrogen and ammonia (urea)
138
how much water is reabsorbed
178-179 litres
139
how much water is secreted
1-2 litres
140
how much glucose shold be present in the urine
0 g
141
what does glucose in urine mean
indication for diabetes
142
where does the majority of water absorption happen
in the PCT
143
describe the descending loop (of Henle) permeability
impermeable to solutes, permable to water
144
describe the ascending loops (of Henle) permeability
impermeable to water
permeable to sodium and chloride ions
145
what is countercurrent multiplication
process where loop of Henle pumps NaCl OUT of ascending, allowing for more reabsorption of water
produces concentrated urine
146
by the end of the DCT, ___ % of water and solutes have been reabsorbed
95
147
what 2 things happen when blood pressure drops
renin-angiotensin-aldosterone system
ADH release
148
what is angiotensin II
a potent vasoconstrictor
149
explain the renin-angiotensin-aldosterone system
renin released from kidneys activates angiotensin I
ACE converts angio I to angio II
angio II contsricts arterioles (inc BP) and triggers adrenal release of aldosterone
aldosterone promotes Na reabsorption > water retention > increase BP
150
explain the role of the release of ADH when BP drops
promotes facultative water reabsorption in the kidney, back into the blood to increase BP
151
what happens when BP rises
atrial natriuretic peptide
152
how does ANP regulate high BP
released from heart when stretched (from too much blood volume)
dilates afferent arteriole
increases GFR, decreases BP
153
what is ANP
atrial natriuretic peptide
154
what is shown here
"the nephrogram pahse"
only in nephrons, IMMEDIATE
155
what is shown here
contrast in minor and major calyces
156
how many major calyces are shown here (on each side)
2 in each kidney
157
where are the ureters
retroperitoneal
anterior to psoas muscle
158
what portion of the ureter is the most anterior
the middle
159
how long are the ureters
10-12" long
160
what moves the urine to the urinary bladder
peristalsis, plus gravity
161
what is the UPJ
uteropelvic junction
"up" junction
162
what is the UVJ
uterovesicle junction
163
does the UVJ have an anatomic valve?
no
164
what is 2
ureter
165
what is 7
IVC
166
what 3 places do kidney stones get caught
UP junction
UV junction
pelvic brim where the iliac vessels cross anteriorly
167
RPO 30 deg oblique best demonstrates what
right UP junction
LEFT kidney
168
RPO 45 oblique
left UV junction
169
how to best demonstrate right UP junction
RPO 30 deg oblique
170
how to best demonstrate left kidney
RPO 30 oblique
171
how to best demonstrate left UV junction
RPO 45deg oblique
172
what is shown here
phleboliths - calcified vessel or vein
173
what does phlebo mean
veins
174
what are common calcified gastric veins, commonly shown in pelvic images
phleboliths
175
how much urine can the bladder hold
700-800 mls
176
what shape is the bladder
round
pear shaped when super full
177
what is the trigone of the bladder
the smooth part with no rugae
178
what does the trigone of the bladder contain
2 uretal openings
1 internal urethral orifice
179
does the bladder have rugae
all but the trigone does
180
what is this image used to view
if there's any urinary reflux
(ureter has no valve)
181
why can urinary reflux be bad
because bladder infections could travel up to the kidneys
182
in females, the bladder is inferior to the ___
uterus
183
how long is the female urethra
4cm
184
how long is the male urethra
20 cm
185
what are the 3 distinct parts of the male urethra
prostatic
membranous
spongy
186
what is 10
bladder
187
what is 11
urethra
188
what is 15
pubic symphysis
189
what is 6
spongy urethra
190
what is 11
membranous urethra
191
what is 12
prostatic urethra
192
what is 20
urinary bladder
193
where does a transplanted kidney go
down in the pelvis, on the swapped side (?)
194
what is being shown here
calcified bones
osteolastic lesions
195
what levels do the kidneys go from
T12 to L3
