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Urinary System.

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Presentation on theme: "Urinary System."— Presentation transcript:

1 Urinary System

2 FUNCTIONS MAINTAIN HOMEOSTASIS OF pH, COMPOSITION AND VOLUME OF BODY FLUIDS REMOVES: METABOLIC WASTE, EXCESS MATERIAL, FOREIGN SUBSTANCES (DRUGS)

3 PARTS KIDNEYS URETER S URINARY BLADDER URETHRA FUNCTIONS?

4

5 KIDNEYS LOCATED RETROPERITONEALLY
12TH THORACIC TO 3RD LUMBAR VERTEBRAE RENAL SINUS AT HILUM: BLOOD VESSELS, URETER, NERVES, LYMPHATIC VESSELS RELEASES ERYTHROPOIETIN ? RELEASES RENIN ? BLOOD PRESSURE ACTIVATES VITAMIN D ? CALCIUM ABSORPTION

6

7

8 RENAL PELVIS RENAL MEDULLA: RENAL CORTEX:
FUNNEL SHAPED SAC AT URETER ORIGIN WHERE MAJOPR CALYCES MERGE RENAL MEDULLA: RENAL PYRAMIDS MINOR CALYCES TO MAJOR CALYCES RENAL CORTEX: OUTER LAYER DIPS IN BETWEEN PYRAMIDS = RENAL COLUMNS RENAL CAPSULE FIBROUS CONNECTIVE TISSUE PROTECTION, MAINTAIN SHAPE

9 BLOOD VESSELS ARTERIES CAN CARRY 30% OF BLOOD TO KIDNEYS ?
RENAL ARTERY HAS _________________ BLOOD RENAL VEIN HAS _________________ BLOOD

10

11 ARTERIES Descending aorta Renal artery Interlobar artery
Arciform arteries Interlobular arteries Afferent arterioles Glomerulus Efferent arteriole Capillary net

12 NEPHRON FUNCTIONAL UNIT OF KIDNEY 1 MILLION PER PARTS RENAL CORPUSCLE
GLOMERULUS GLOMERULAR OR BOWMAN’S CAPSULE 2 LAYERS OF SQUAMOUS EPITHELIAL VISCERAL AND PARIETAL TO TUBULE VISCERAL CELLS: PODOCYTES HAVE PROCESS AND SECONDARY PROCESSES = PEDICELS, INTERDIGITATE TO FORM SLIT PORES FUNCTION AFFERENT AND EFFERENT ARTERIOLES

13 GLOMERULUS

14

15 PODOCYTES

16 RENAL TUBULE PROXIMAL CONVOLUTED TUBULE NEPHRON LOOP/ LOOP OF HENLE
DESCENDING LIMB ASCENDING LIMB DISTAL CONVOLUTED TUBULE COLLECTING DUCT/ COLLECTING TUBULE THROUGH RENAL PAPILAE TO MINOR CALYX

17 RENAL TUBULE

18 JUXTAGLOMERULAR APPARATUS
ASCENDING LIMB PASSES BETWEEN AFFERENT AND EFFERENT ARTERIOLE MACULA DENSA = TALL DENSELY PACKED CELLS OF ASCENDING LOOP TOUCHING ASCENDING LIMB JUXTAGLOMERULAR CELLS IN WALL OF AFFERENT ARTERIOLE (LARGE VASCULAR SMOOTH MUSCLE CELLS) REGULATES SECRETION OF RENIN (CHAP 13)

19 JUXTAGLOMERULAR APPARATUS

20 NEPHRONS CORTICAL JUXTAMEDULLARY 80%
CORPUSCLE IN CORTEX CLOSE TO SURFACE SHORT NEPHRON LOOPS JUXTAMEDULLARY 20% CORPUSCLE CLOSE TO MEDULLA LONG LOOP MOST RESPONSIBLE FOR H2O HOMEOSTASIS

21 BLOOD SUPPLY OF NEPHRON
AFFERENT ARTERIOLE DIAMETER LARGER THAN EFFERENT ? PERITUBULAR CAPILLARY SYSTEM VASA RECTA AROUND JUXTAMEDULLARY NEPHRON LOOP: LOW PRESSURE

22 URINE FORMATION WASTES, EXCESS WATER, ELECTROLYTES
GLOMERULAR FILTRATION FILTERS INTO NEPHRON RATHER THAN INTERSTITIAL SPACE PRODUCES 180 L OF FLUID/DAY SO MOST? TUBULAR REABSORPTION PICKS UP RIGHT AMOUNT OF WATER, ELECTROLYTES, GLUCOSE TUBULAR SECRETION REMOVES H+, TOXINS FASTER URINARY SECRETION = GLOMERULAR FILTRATION + TUBULAR SECRETION – TUBULAR REABSORPTION

23 GLOMERULAR FILTRATION
MORE PERMEABLE TO SMALL MOLECULES: FENESTRATED CAPILLARIES = WATER,GLUCOSE, AMINO ACIDS, UREA, URIC ACID, CREATINE, CREATININE, SODIUM, CHLORIDE, POTASSIUM, CALCIUM, BICARBONATE, PHOSPHATE, SULFATE

24 FENESTRATED CAPILARIES

25 FILTRATION PRESSURE HYDROSTATIC PRESSURE CAUSES FILTRATION
ALSO AFFECTED BY HYDROSTATIC PRESSURE IN CAPSULE AND OSMOTIC PRESSURE IN PLASMA ? NET FILTRATION RATE = GLOMERULAR CAPILLARY HYDROSTATIC PRESSURE – CAPSULAR HYDROSTATIC PRESSURE AND GLOMERULAR CAPILLARY OSMOTIC PRESSURE

26 NEPHRON RAP

27 URINARY SYSTEM

28 DIALYSIS

29 FILTRATION RATE FILTRATION RATE AFFECTED BY ANYTHING THAT AFFECTS GLOMERULAR HYDROSTATIC PRESSURE, GLOMERULAR PLASMA OSMOTIC PRESSURE, OR CAPSULAR HYDROSTATIC PRESSURE GLOMERULAR HYDROSTATIC PRESSURE IS MOST IMPORTANT: ANY CHANGE IN DIAMETER OF ARTERIOLES, VASODILATION? VASOCONSTRICTION? MORE FLUID IS FILTERED BECAUSE OF HIGHER HYDROSTATIC PRESSURE SO COLLOIND OSMOTIC PRESSURE DOESN’T AFFECT FILTRATION AS MUCH, UNLESS IT IS LOWERED ?

30 ANY OBSTRUCTION (?) WOULD BACK UP FLUID RAISING THE HYDROSTATIC PRESSURE OF CAPSULE AND REDUCING FILTRATION FILTERS: 25% CARDIAC OUTPUT; 20% OF PLASMA = 125 ml/MIN; 180 L/DAY : SO PLASMA IS FILTERED 60X/DAY = 45G SURFACE AREA OF GLOMERULAR CAPILLARIES = 2 sq m = SKIN’S SURFACE

31 CONTROL OF FILTRATION RATE GFR
MAINLY AUTOREGULATION BP/VOLUME DROP STIMULATES SYMPATHETIC NS = VASOCONSTRICTION OF AFFERENT ARTERIOLES = ? IF BP/VOLUME INCREASE = ? RENIN-ANGIOTENSIN SYSTEM: RENAL BAROMETERS OF AFFERENT ARTERIOLES STIMULATE SYMPATHETIC NS TO STIMULATE JUXTAGLOMERULAR CELLS SECRETE RENIN

32 DECREASING LEVELS OF SODIUM, POTASSIUM, CHLORIDE STIMULATE MACULA DENSA TO SECRETE RENIN
RENIN STIMULATES ANGIOTENSINOGEN  ANGIOTENSIN I; ANGIOTENSIN-CONVERTING ENZYME CAHNGES ANGIOTENSIN I  ANGIOTENSIN II ANGIOTENSIN II: MAINTAINS SODIUM BALANCE, WATER BALANCE, BLOOD PRESSURE CONSTRICTS AFFERENT OR EFFERENT ARTERIOLES, STIMULATES SECRETION OF ALDOSTERONE FROM ADRENAL CORTEX

33 ANP: (FROM?) RELEASED WHEN BLOOD VOLUME INCREASES: SO ?
ANGIOTENSIN II: VASOCONSTRICTOR OF AFFERENT AND EFFERENT ARTERIOLES STIMULATE PRODUCTIN OF ALDOSTERONE: (FROM?) CAUSES RETENTION OF SODIUM IN DISTAL TUBULE: LOSES LESS WATER STIMULATES RELEASE OF ADH: INCREASES PERMEABILITY OF DISTAL TUBULE AND COLLECTING DUCT ANP: (FROM?) RELEASED WHEN BLOOD VOLUME INCREASES: SO ?

34 TUBULAR REABSORPTION REABSORPTION: MATERIAL TRANSPORTED OUT TO INTER STITIAL FLIUD AND DIFFUSE INTO PERITUBULAR CAPILLARIES PASSIVE AND ACTIVE MECHANISMS CAUSED BY: LOW HYDROSTATIC PRESSURE OF PERITUBULAR CAPILLARIES, HIGH PERMEABILITY OF CAPILLARIES, HIGHER COLLOID OSMOTIC PRESSURE OF PERITUBULAR CAPILLRIES

35 MOSTLY IN PROXIMAL TUBULE, HAVE MICOVILLI (?)
GLUCOSE: PROXIMAL: ACTIVE TRANSPORT UNLESS RENAL PLASMA THRESHOLD IN REACHED (DIABETES) WATER: PROXIMAL: OSMOSIS AMINO ACIDS: SMALL PROTEINS: PROXIMAL: ACTIVE TRANSPORT: ENDOCYTOSIS CREATINE, LACTIC, CITRIC, URIC AND ASCORBIC ACID: ACTIVE TRANSPORT ACTIVE TRANSPORT REQUIRES CARRIER MOLECULES

36 SODIUM AND WATER RETENTION
WATER: OSMOSIS TIED IN WITH RETENTION OF SODIUM SODIUM PUMP IN PROXIMAL SECTION CHLORIDE, PHOSPHATE AND BICARBONATE MOVE WITH SODIUM IONS MOST REABSORPTION IN PROXIMAL TUBULE (70%) MOST SODIUM IS RETAINED (97-99%)

37 TUBULAR SECRETION EPITHELIAL CELLS OF TUBULES SECRETE SUBSTANCES
ACTIVE TRANSPORT: ORGANIC COMPOUNDS LIKE PENICILLIN, HISTAMINE HYDROGEN IONS: WHY? POTASSIUM: WHEN ALDOSTERONE CAUSES REABSORPTION OF SODIUM = NEGATIVE CHARGE AND POTASSIUM IS SECRETED

38 REGULATION OF URINE CONTENT
HORMONES: ANP; ALDOSTERONE; ADH ADH FROM ? POSTERIOR PITUITARY CAUSES DISTAL CONVOLUTED TUBULE AND COLLECTING DUCTS TO ADD PROTEINS – AQUAORINS: WATER CHANNELS: OSMOSIS BECAUSE OF HYPERTONIC MEDULLA COUNTERCURRENT EFFECT: ASCENDING LOOP IMPERMEABLE TO WATER BUT LETS ELECTROLYTES OUT SO INSIDE IS HYPOTONIC AND OUTSIDE IS HYPERTONIC

39 DECENDING LOOP IS PERMEABLE TO WATER NOT SOLUTES, HYPERTONIC OUTSIDE SO WATER DIFFUSES OUT: TUBULAR FLUID IS CONCENTRATED ASCENDING LOOP REABSORBS MORE SALT, SALT CONCENTRATION KEEPS MULTIPLYING: COUNTERCURRENT MULTIPLIER MORE THAN 4X SOLUTE CONCENTRATION THAN PLASMA SALT DIFFUSES INTO DESCENDING VASA RECTA BUT DIFFUSES OUT OF ASCENDING: MAINTAINS SALT GRADIENT IN MEDULLA

40 mhhe.com

41 UREA AND URIC ACID PRODUCTION
AMINO ACID BREAKDOWN FOR GLUCONEOGENESIS URIC ACID METABOLISM OF A AND G 10% EXCRETED/ MOST REABSORBED

42 URINE COMPOSITION VARIES ?
95% ?;UREA, URIC ACID, CREATINE, TRACE AMINO ACIDS, ELECTROLYTES DIET & PHYSICAL ACTIVITY

43 VOLUME .6-2.5L 50-60 ml/MIN LESS THAN 30 ml/min = KIDNEY FAILURE

44 RENAL CLEARANCE DEFINITION: KIDNEY’S EFFICIENCY AT REMOVING A SUBSTANCE TESTED TO SEE IF DISEASE OR DAMAGE INSULIN CLEARANCE TEST: GFR CREATININE CLEARANCE TEST: GFR: KIDNEY FUNCTION: USUALLY ALL REMOVED FROM BLOOD TO URINE

45 URETERS 25 cm BEHIND PARIETAL PERITONEUM TO URINARY BLADDER 3 LAYERS:
MUCOUS COAT: TRANSITIONAL EPITHELIUM MUSCULAR COAT: SMOOTH MUSCLE: CIRCULAR AND LONGITUDINAL LAYERS FIBROUS COAT: CONNECTIVE TISSUE MOVES BY PERISTALSIS: STARTED BY PRESENCE OF URINE VALVE AT URINARY BLADDER ? KIDNEY STONE COULD INCREASE PERISTALSIS OR SYMPATHETIC NS CONSTRICTS URETER AND KIDNEY SHUTS DOWN

46 URINARY BLADDER HOLLOW, BEHIND PARIETAL PERITONEUM
TRIGONE: OPENINGS TO URETER AND URETHRA MUCOUS COAT: TRANSITIONAL EPITHELIUM SUBMUCOSA: CONNECTIVE TISSUE WITH GLAND CELLS MUSCULAR COAT: SMOOTH MUSCLE: DETRUSOR MUSCLE: FORMS INTERNAL URETHRAL NECK

47 ALWAYS SUSTAINED CONTRACTION
PARASYMPATHETIC NS: REFLEX FOR URINATION SEROUS COAT: PARIETAL PERITONEUM AT TOP, FIBROUS CONNECTIVE TISSUE REST

48 URETHRA MUCOUS MEMBRANE LONGITUDINAL SMOOTH MUSCLE FIBERS
URETHRAL GLANDS: MUCOUS GLANDS MALES: PROSTATIC URETHRA PASSES THROUGH PROSTATE; MEMBRANOUS URETHRA EXTERNAL URETHRAL SPHINCTER; PENILE URETHRA

49 MICTURITION MICTURITION REFLEX:
STRETCH RECEPTORS STIMULATED; SIGNAL MICTURITION REFLEX CENTER: IN SACRAL SPINAL CORD PARASYMPATHETIC NS IMPULSE TO DETRUSOR MUSCLE TO CONTRACT CAN STILL BE CONTROLED: EXTERNAL URETHRAL SPHINCTER, IMPULSES FROM BRAIN STEM AND CEREBRAL CORTEX EXTERNAL URETHRAL SPHINCTER RELAXES: IMPULSES FROM HYPOTHALAMUS AND PONS DETRUSOR MUSCLE CONTRACTS: MICTURITION IMPULSES STOP; DETRUSOR MUSCLE RELAXES, BLADDER FILLS

50 LIFE SPAN CHANGES KIDNEY CELLS START TO DIE AT 20 BUT NOT NOTICED TILL AFTER 40; 1/3 LOSS BY 80 GLOMERULI SHUT DOWN: LOSS; DAMAGE; GFR DROPS AT 40; 75: 125ml  60ml RENAL TUBULES THICKEN WITH FATTY ACIDS; DON’T PROCESS DRUGS AND ORGANICE MATERIAL AS WELL BLOOD FLOW DECREASES BY 80

51 SLOWER TO RESPOND FOR HOMEOSTASIS:
ARTERIOLES DON’T DILATE AS QUICK RELEASE OF RENIN DECREASES CAN’T ACTIVATE VITAMIN D URETER, URINARY BLADDER AND URETHRA AREN’T AS ELASTIC: BLADDER HOLDS 50% LESS AND RETAINS MORE: MORE FREQUENT URINATION AND MORE URGENT INCONTINENCE: LOSS OF MUSCLE TONE OF BLADDER


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