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Anatomy and Physiology > Urinary system > Flashcards

Urinary system Flashcards

1
Q

What is osmosis?

A

the movement of water across a partially permeable membrane from a dilute/hypotonic solution (with low osmotic pressure) to a more concentrated/hypertonic solution (with a higher osmotic pressure) in an attempt to achieve an isotonic balance

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2
Q

What is osmotic pressure?

A

the pressure exerted in pulling water across the partially permeable membrane

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3
Q

What is diffusion?

A

the movement of solutes from an area of high concentration to an area of low concentration in an attempt to achieve an isotonic balance

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4
Q

What is filtration?

A

the movement of water and solutes from an area of higher pressure to an area of lower pressure, usually across a partially permeable membrane, due to the hydrostatic pressure of the fluid

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5
Q

What is active transport?

A

the movement of solutes across a membrane (usually) against a concentration gradient involving the use of ATP and carrier proteins
the molecule may be too large to move by diffusion or the higher concentration on the other side of the membrane may prevent diffusion

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6
Q

How does the hypothalamus influence water balance?

A

monitors fluid volume and osmolality via osmoreceptors
osmolality is the concentration of particles dissolved in the weight of a fluid, providing a representation of water balance and hydration in the body (normal range 285-295 mOsm/kg)
initiates actions to excrete, retain or obtain water and electrolytes through different systems

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7
Q

How does the kidney influence water balance?

A

via renal excretion and absorption in response to hormonal stimuli and blood volume

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8
Q

How does the movement of fluid influence water balance?

A

fluid moves between fluid compartments due to hydrostatic and osmotic pressures and capillary and cell membrane integrity

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9
Q

What are the main functions of water?

A

to provide a transport medium
to assist in thermoregulation
to act as a solvent, permitting chemical reactions to occur

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10
Q

On average, what percentage of our body weight is accounted for by water?

A

60%
infants have 75% water composition
older adults have 55% water composition

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11
Q

Under normal conditions, approximately how many litres of fluid does a healthy adult require daily to replace fluid lost through faeces, respiration, perspiration (diaphoresis) and urine?

A

2.5 L

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12
Q

What are insensible losses?

A

water losses that are not possible to measure in everyday life

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13
Q

How does the nervous system maintain water and electrolyte homeostasis?

A

a dehydrated person has a low ECF volume
water moves by osmosis from ICF to ECF
this causes cell shrinkage detected by osmoreceptors in the anterior hypothalamus and preoptic area of the brain
thirst is stimulated by a decrease in plasma volume of 10-15%
once a person starts to drink, taste receptors signal to the brain to relay this, quenching thirst even before blood volume increases
increased blood volume triggers anterior hypothalamus to signal sufficient water intake has been achieved but this response is slower as time for absorption is needed

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14
Q

What is oedema?

A

swelling of the tissues due to fluid accumulation

peripheral oedema involves swelling of the feet and ankles, or any dependent body parts

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15
Q

What is ascites?

A

swelling of the abdomen due to fluid accumulation
it may occur in liver disease or heart failure, but is also seen in kwashiorker when the lack of adequate protein in the diet, and the resulting low levels of plasma proteins, lead to a low plasma osmolality and reduced fluid re-entering the blood stream from the interstitial fluid

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16
Q

What are some of the age-associated renal changes that occur as people progress into older adulthood?

A

renal mass is reduced by glomerular loss and sclerosis which impairs water and sodium preservation and increases likelihood of dehydration and hyponatraemia
increased risk of hypertension causes more ANP to be released and less ADH and aldosterone
thirst response is reduced which makes behavioural responses to dehydration less efficient

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17
Q

What are electrolytes?

A

positively or negatively charged ions dissolved within body fluids

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18
Q

What is sodium (Na+)?

A

main cation in ECF
involved in generating osmotic pressure and transmission of nerve impulses
aldosterone promotes sodium reabsorption in the renal tubules
excess sodium is excreted in urine and is enhanced by ANP release from the myocardium
an adult needs 1-2 mmol of sodium per kilogram of body weight daily

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19
Q

What is potassium (K+)?

A

main cation in ICF
controls osmotic pressure and involved in transmission of nerve impulses
low potassium in ECF causes the cell to sacrifice potassium (and water) into ECF
regulation of potassium in ICF and ECF is central to optimal cell metabolism as potassium has a key role in activating cell enzymes
renal nephrons promote potassium reabsorption in the renal tubules or excrete it into urine as necessary
an adult needs 0.5 mmol of potassium per kilogram of body weight daily

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20
Q

What is calcium (Ca2+)

A

most abundant in ECF
stored in organelles so ICF value reads very low
cells can pump calcium in when needed
important in blood clotting and deposited in bones
stimulates muscle contraction and involved in transmission of nerve impulses
an adult needs 20 mmol of calcium daily, two thirds of which is excreted in faeces
calcium is also excreted by the kidneys, but 65% of the calcium filtered into the renal tubule is reabsorbed with sodium in the PCT and ascending loop of Henle

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21
Q

What is magnesium (Mg2+)

A

second most abundant cation in ICF
essential for many metabolic processes (e.g. formation and use of ATP, formation of nucleic acids and proteins)
keeps concentrations of potassium, calcium and phosphorus in ICF stable which is essential for the stability of the conduction system of the heart
magnesium has calcium channel blocking properties for all muscle types to prevent arrhythmias of the heart
absorbed in the small intestine and excreted by renal filtration

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22
Q

What is bicarbonate (HCO3-)?

A

alkaline buffer produced from carbonic acid
important in osmotic pressure
pancreas releases bicarbonate, under the influence of secretin, into the small intestine to neutralise acidic chyme from the stomach
bicarbonate levels are balanced in the renal tubule, where it can be excreted or absorbed

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23
Q

What is chloride (Cl-)?

A

main anion in ECF
role in pH balance and production of hydrochloric acid in the stomach
taken in the diet and absorbed in the small intestine
elimination occurs in the renal tubules, where it can be excreted or reabsorbed

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24
Q

What is phosphate (PO43-)?

A

most abundant in ICF
important in bone mineralisation and structural components of cells (e.g. phospholipids, nucleotides, phosphoproteins)
important in storage of ATP, transfer of oxygen, and acts as a buffer
stored in teeth and bone
taken in the diet and elimination occurs in the PCT
homeostasis of calcium, magnesium, phosphorus and parathyroid hormone are interrelated, with changes in one impacting on the other

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25
Q

What are crystalloids?

A

e.g. normal saline (0.9% sodium chloride, which is isotonic) and Hartmann’s solution (a compound sodium lactate crystalloid solution that is similar in concentration to blood)
consist of a specified balance of water and electrolytes
remain in plasma for a short time and move easily between fluid compartments
sodium is usually the main osmotically active solute
crystalloids are mainly for restoring and maintaining fluid and electrolyte homeostasis

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26
Q

What are colloids?

A

e.g. blood, albumin and starch solutions, and plasma expanders
high molecular weight so remain in the plasma for longer
as they contain substances that do not dissolve into a true solution, they contribute to (colloid) osmotic pressure and fluid diffuses into plasma

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27
Q

What is the renal system composed of?

A

two kidneys, two ureters (one from each kidney) which transport urine to the bladder, and one urethra enabling excretion of urine from the body

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28
Q

What are the key functions of the renal system?

A

excretion (removal of organic wastes from body fluids)
elimination (discharge of waste products)
homeostatic regulation

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29
Q

Where are the kidneys positioned?

A

on the posterior abdominal wall within the peritoneal cavity

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30
Q

What is the average size of the kidneys?

A

11-14 cm in length, 6 cm wide, 4 cm thick

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31
Q

What three layers of tissue surround each kidney?

A

renal capsule (inner layer), adipose capsule (middle layer), renal fascia (outer layer)

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32
Q

What is the structure and function of the renal capsule (inner layer)?

A

consists of a smooth, transparent sheet of irregular connective tissue that is continuous with the outer coat of the ureter
it serves as a barrier against trauma and helps maintain the shape of the kidney

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33
Q

What is the structure and function of the adipose capsule (middle layer)?

A

mass of fatty tissue which surrounds the renal capsule

protects the kidney from trauma and holds it firmly in place in the abdominal cavity

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34
Q

What is the structure and function of the renal fascia (outermost layer)?

A

consists of a thin layer of dense irregular connective tissue
anchors the kidney to the surrounding structures and to the posterior abdominal wall

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35
Q

What are the two distinct regions within the kidney?

A

renal cortex and renal medulla

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36
Q

What is the structure of the renal cortex?

A

extends from the renal capsule to the bases of the renal pyramids and the spaces between them (renal column)
the renal cortex has two zones - cortical zone (outer) and juxtamedullary zone (inner)

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37
Q

What is the structure of the renal medulla?

A

innermost layer
consists of pale conical-shaped striations called renal pyramids (consisting of the base and renal papilla/apex)
the base of the pyramid faces the renal cortex and the apex faces the renal hilum

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38
Q

What does a renal lobe consist of?

A

a renal pyramid, its overlying area of renal cortex and one half of the adjacent renal column

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39
Q

What is a nephron?

A

the major functional unit of the kidney
filtrate formed here drains into papillary ducts (which extend through the renal papillae) and into minor (8-18) and major (2-3) calyces (cuplike structures)

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40
Q

What is the function of a minor calyx?

A

to receive urine from the papillary ducts of one renal papilla and deliver it to a major calyx
once the filtrate enters the calyx it is known as urine as no further reabsorption can take place

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41
Q

How does the kidney contribute to the maintenance of homeostasis?

A

regulates blood volume and blood pressure by adjusting the volume of water lost in urine; production of renin
regulates plasma ion concentrations by controlling quantities of sodium, potassium and chloride ions lost in urine
helps control calcium ion levels through the synthesis of calcitrol (the active form of vitamin D, produced by modification of vitamin D in the liver then the kidney).
stabilises blood pH by controlling the loss of hydrogen and bicarbonate ions in urine
prevents excretion of nutrients while excreting organic waste products
helps the liver to detoxify poisons

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42
Q

Which arteries deliver blood to the kidney?

A

renal artery - arising from the abdominal artery
segmental arteries - branches of the renal artery
interlobar arteries - found between renal pyramids and a branch of the segmental artery

43
Q

What are arcuate arteries?

A

interlobar arteries that branch between the medulla and the cortex at the base of the pyramid

44
Q

What are interlobular arteries?

A

divisions of the arcuate arteries which pass between renal lobes
they enter the renal cortex and branch off to afferent arterioles

45
Q

What do afferent arterioles divide into?

A

a capillary network called the glomerulus

46
Q

What do glomerular capillaries reunite to form?

A

efferent arterioles

47
Q

What do efferent arterioles unite to form?

A

peritubular capillaries (surrounding tubular parts of the nephron)

48
Q

What do peritubular veins unite to form?

A

interlobular veins

49
Q

What do interlobular veins unite to form?

A

arcuate veins

50
Q

What do arcuate veins unite to form?

A

interlobar veins

51
Q

How does blood leave the kidney?

A

via the renal vein through the hilum to the inferior vena cava

52
Q

Where do renal nerves originate?

A

renal ganglion

53
Q

What do renal nerves pass through?

A

renal plexus

54
Q

What are most of the nerves supplying the kidney called?

A

vasomotor nerves

55
Q

How do vasomotor nerves function?

A

they regulate blood flow by vasoconstriction or vasodilation of renal arterioles

56
Q

What does each nephron consist of?

A

renal corpuscle - spherical structure consisting of the glomerulus and Bowman’s capsule
renal tubule - consists of a long tubular passageway divided into the proximal convoluted tubule (PCT), loop of Henle and the distal convoluted tubule (DCT)

57
Q

How many nephrons are in each kidney?

A

about 1.25 million

58
Q

What three processes does the nephron undertake in urine formation?

A

filtration in the renal corpuscle
reabsorption in the PCT, loop of Henle, DCT and collecting duct
secretion in the DCT

59
Q

What is the structure and function of the Bowman’s capsule?

A

lined with epithelial cells
acts as a filter of blood entering via the afferent arteriole
the juxtaglomerular apparatus is situated in this area and contributes to regulation of fluid and electrolyte balance

60
Q

What is the structure of the proximal convoluted tubule (PCT)?

A

consists of closely fused cuboidal epithelial cells with many mitochondria and a brush border

61
Q

What is the function of the proximal convoluted tubule (PCT)?

A

in a healthy kidney virtually all the nutrients (glucose and amino acids) and most of the electrolytes (sodium, chloride and bicarbonate) are reabsorbed here with the amount of water which retains the osmolality of the filtrate
about two thirds of the filtrate is reabsorbed
this plays no part in electrolyte homeostasis and is called the obligatory phase of reabsorption

62
Q

What is the structure of the loop of Henle?

A

this section of the tubule dips down into the medulla and back up again
the cells in the cortex are thick but the cells of the descending limb become thin and permeable
the first part of the ascending limb towards the cortex is similar but then the cells become thick with many mitochondria

63
Q

What is the function of the loop of Henle?

A

creates an osmotic gradient through the medulla
the thick section of the ascending loop of Henle moves sodium (as NaCl) from the filtrate into the interstitial fluid by active transport using ATP
this means filtrate with a low sodium concentration reaches the DCT
water moves into the interstitial fluid by osmosis from the descending loop of Henle and collecting duct
water is reabsorbed by capillaries and re-enters the blood circulation

64
Q

What is the structure of the distal convoluted tubule (DCT)?

A

similar to that of the upper part of the ascending loop of Henle

65
Q

What is the function of the distal convoluted tubule (DCT)?

A

regulates the electrolyte balance in the body
RAAS regulates the amount of ions reabsorbed by the DCT
aldosterone stimulates reabsorption of sodium into the interstitial fluid and secretion of potassium into the tubular filtrate
intercalated cells actively secrete H+ ions into the filtrate and reabsorb bicarbonate remaining in the filtrate after reabsorption in the PCT
this can result in a pH as low as 4 to 4.5 which leads to excretion of acid urine

66
Q

What is the function of the collecting duct?

A

collects the filtrate from a number of nephrons
the quantity of water reabsorbed into the body through this duct is mainly regulated by ADH
if body fluids have a high osmolality (>290 mOsm/kg) then ADH secretion increases and more water is reabsorbed leading to less dilute urine excreted
if body fluids have a low osmolality then ADH secretion decreases and less water is reabsorbed leading to more dilute urine excreted
filtrate passes through collecting ducts via the calyces into the pelvis of the kidney and then the ureter

67
Q

Urine is formed through which three physiological processes?

A

filtration, selective reabsorption, secretion

68
Q

How is urine formed through filtration?

A

hydrostatic pressure and osmotic pressure force water and solutes across the glomerular capillary wall into the Bowman’s capsule (glomerular filtration)
glomerular filtrate consists of water, sodium, glucose and waste products
glomerular filtration rate (GFR) is the rate at which the filtrate is formed and is measured in ml/m (normally about 125 ml/m in adults)
GFR is estimated by examining the excretion rate of a substance (e.g. creatinine) which is readily filtered but neither reabsorbed nor secreted in the nephron, and which does not alter renal function

69
Q

What is hydrostatic pressure?

A

the pressure by blood on the surfaces of vessel walls causing fluid to be pushed out of the capillary and into the interstitial fluid

70
Q

What are the two types of hydrostatic pressure involved in filtration?

A

glomerular hydrostatic pressure (GHP) - blood pressure in glomerular capillaries
capsular hydrostatic pressure (CHP) - pressure in the capsular space due to resistance to flow along the nephron

71
Q

What is net hydrostatic pressure (NHP)?

A

difference between GHP and CHP (approximately 35 mmHg)

72
Q

What is blood colloid osmotic pressure (BCOP)?

A

results from the presence of proteins in a solution
plasma proteins influence the movement of water between the intravascular space and interstitial compartment
colloids form colloidal complexes that do not pass through membranes easily due to their size, remaining in the intravascular space
these proteins (mainly albumin) on the plasma side of the membrane give rise to a colloid osmotic gradient that pulls fluids and solutes from interstitial spaces into the intravascular space
BCOP is 25 mmHg

73
Q

How can you calculate the filtration pressure?

A

NHP - BCOP = FP

35 mmHg - 25 mmHg = 10 mmHg

74
Q

What is selective reabsorption?

A

the movement of fluids and solutes from the tubular filtrate into the peritubular capillaries
occurs via osmosis, diffusion and active transport
it allows the body to retain fluids, and desired solutes (approx. 99% of the glomerular filtrate) are returned to the blood

75
Q

What are the percentages of water, solutes and electrolytes reabsorbed in the PCT?

A 
water 65%
sodium 65%
chloride 50%
potassium 65%
glucose 100%
amino acids 100%
bicarbonate 80-90%
calcium (variable amounts)
magnesium (variable amounts)
urea 50%
76
Q

What are the percentages of water, solutes and electrolytes reabsorbed in the loop of Henle?

A 
water 15%
sodium 20-30%
chloride 35%
potassium 20-30%
bicarbonate 10-20%
calcium (variable amounts)
magnesium (variable amounts)
77
Q

What are the percentages of water, solutes and electrolytes reabsorbed in the DCT?

A 
water 10-15%
sodium 5%
chloride 5%
calcium (dependent on body's needs)
urea
78
Q

What is secretion?

A

the removal of waste products and substances not required by the body
extracted from blood, passed into convoluted tubules and collecting ducts and excreted in urine
includes waste products of metabolism (urea, creatinine, ammonium ions), foreign materials (e.g. drugs), H+ or HCO3- ions to regulate pH, and some hormones

79
Q

What is urine?

A

yellowish liquid approx. 95% water and 5% dissolved solids and gases
pH 4.5-8.0 (average 6.0)
specific gravity (SG) (amount of dissolved substances in it) 1.002 (very dilute) to 1.040 (very concentrated)
normal urine composition includes: water, urea, uric acid, creatinine, ammonia, sodium, potassium, chloride, bicarbonate, calcium, magnesium and phosphate
urine should not contain: protein, glucose, blood, ketones, leucocytes and casts (solid material moulded within the tubules which consists of cells or proteins)
presence of any of these substances suggests infection or underlying kidney disease

80
Q

What are the ureters?

A

two tubes about 30 cm in length
collect urine from the calyces of the kidneys and drain it into the bladder by peristalsis through the action of the circular and longitudinal muscle fibres
this oblique entry minimises reflux of urine back into the ureters as the bladder fills

81
Q

What is the vesicoureteral reflux?

A

this occurs when this oblique entry of the ureter into the bladder is straightened and allows backflow of urine from the bladder into the ureter
this enables bacteria to ascend from the bladder into the kidneys and cause infection

82
Q

What is the trigone?

A

a smooth triangular part of the bladder where the ureters enter
the corners are identified by the two ureteric openings and the internal urethral orifice
when stretched, receptors in this area signal expansion and, when stretched sufficiently, indicate the need to micturate
this particular part of the bladder is derived from the same tissue as the anterior part of the vagina and responds to oestrogen in the same way

83
Q

What is the structure of the bladder?

A

detrusor muscle formed of smooth muscle fibres in spiral, longitudinal and circular bundles
this empties the bladder by contraction in micturition
bladder lining is formed of transitional epithelium which enables expansion to hold urine
when empty, the bladder walls fold into ridges/rugae
as the bladder fills these unfold increasing the volume which can be held

84
Q

What is the function of the urethra?

A

to carry urine from the bladder to the external urinary meatus to remove excess fluid from the body
in males, it carries semen as well as urine

85
Q

What is the structure of the female urethra?

A

4.8-5.1 cm long
exits the body through the external meatus of striated voluntary muscle between the clitoris and the vagina
the three layers of the urethra are: muscular (continuous with that of the bladder), erectile and mucosal
muscular and erectile layers are lined with transitional epithelium
mucosal layer is lined with stratified squamous epithelium
the opening through the pelvic floor has the external urethral sphincter controlled by the pudendal nerves to control micturition

86
Q

What is the structure of the male urethra?

A

much longer and more variable in length than the female urethra
15-29 cm
divided into four parts

87
Q

What are the four sections of the male urethra?

A

pre-prostatic, prostatic, membranous and spongy (penile)

88
Q

What is the structure of the pre-prostatic region of the male urethra?

A

passes through bladder wall
0.5-1.5 cm long depending on fullness of bladder
transitional epithelium

89
Q

What is the structure of the prostatic region of the male urethra?

A

passes through prostate gland
openings: ejaculatory duct and prostatic ducts
transitional epithelium

90
Q

What is the structure of the membranous region of the male urethra?

A 
1-2 cm portion passing through external urethral sphincter 
narrowest part of the urethra
bulbourethral glands (posterior to this section but open in spongy urethra)
pseudostratified columnar
91
Q

What is the structure of the spongy region of the male urethra?

A

runs along the underside of the penis
15-16 cm in length, passes through corpus spongiosum
openings: urethral gland and bulbourethral glands
lumen runs parallel to penis, except at narrowest point, the external urethral meatus, where it is vertical
results in spiral stream of urine which cleans external urethral meatus
(lack of equivalent mechanism in female urethra partly explains increased incidence of UTIs in females)
pseudostratified columnar - proximally
stratified squamous - distally

92
Q

How does the micturition reflex work?

A

controlled by the sacral segments of the spinal cord while stimuli are passed to the micturition centre in the pons and to the cerebrum
this allows voluntary control over the autonomic nerves of the micturition reflex

93
Q

What are the two stages of bladder activity?

A

storing (guarding) and voiding

94
Q

What happens during the storing stage?

A

distension of the bladder occurs as urine collects
when about 150 ml has gathered, the stretching provides a stimulus to the sympathetic nervous supply to the bladder
this inhibits contraction of the detrusor and constricts the internal urethral sphincter around the neck of the urethra, preventing micturition
when about 400 ml has gathered, a desire to pass urine occurs and is prevented by voluntary contraction of the external urethral sphincter through the pudendal nerves

95
Q

What happens during the voiding stage?

A

neurons in the micturition centre send maximum impulses to the sacral centre
parasympathetic fibres stimulate contraction of the bladder and relaxation of the internal urethral sphincter
external urethral sphincter is consciously relaxed which enables micturition to occur

96
Q

What are the various types of urinary incontinence?

A 
stress urinary incontinence
urge incontinence
mixed incontinence
overflow incontinence
reflex incontinence
enuresis (involuntary loss of urine)
functional incontinence
97
Q

What is stress urinary incontinence?

A

the urethral sphincter fails to remain closed when there is an increase in abdominal pressure on the bladder (e.g. coughing)

98
Q

What is urge incontinence?

A

the detrusor muscle contracts even if the bladder is not full

99
Q

What is mixed incontinence?

A

a combination of stress and urge incontinence

100
Q

What is overflow incontinence?

A

due to urinary retention that may be caused by obstruction (e.g. tumour), underactive detrusor muscle or failure of the urethra to open

101
Q

What is reflex incontinence?

A

caused by damage to the spinal cord and loss of sensation of the desire to micturate

102
Q

What is enuresis?

A

nocturnal enuresis refers to urinary incontinence that occurs when the person is asleep
it can affect all age groups
may be due to a reduced bladder capacity, inability to concentrate urine at night, and difficulty in waking when the bladder becomes full

103
Q

What is functional incontinence?

A

the person has an underlying condition that prevents them from gaining access to a toilet at the right time

Anatomy and Physiology (13 decks)

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