Question Answer
Kidney location: Cephaled pole: T-12; Caudal pole: L-3; Behind peritoneal cavity, below diaphragm.
Adrenal Glands: Sit on top of each kidney; secrete hormones
Kidney components: Cortex, Medulla, Renal Pyramids, Papillary Ducts, Major & Minor Calyces, Renal Pelvis
Cortex: Dark outer layer of the kidney
Medulla: Pale inner layer which contains the renal pyramids
Renal Pyramids: 8-12 in each kidney; consist of papillary ducts that extend from the cortex to the calyces.
Major & Minor Calyces: Converge into the renal pelvis
Renal Pelvis: Expanded upper end of each ureter
Nephron components: Glomerulus, Bowman’s Capsule, Proximan Convuluted Tubule, Loop of Henle, Distal Convoluted Tubule, Collecting Duct
Renal Corpuscle consists of: Glomerulus & Bowman’s Capsule
Types of capillary beds: Glomerular & Peritubular
Glomerulus function: Filtration of blood to form urine
Peritubular function: Tubular reabsorption
The formation of urine involves: Glomerular filtration, peritubular reabsorption, and tubular secretion (nephron processes)
Glomerular filtration BV’s: Afferent Arteriole: constrict = decreased GFR, dilate = increased GFR; Efferent Arteriole: constrict = increased GFR, dilate = decreased GFR
What is Active Transport & what is included? Reabsorption from tubules into peritubular capillaries; sodium, calcium, amino acids, glucose.
What is secretion & what is secreted? From peritubular capillaries into the tubules; creatinin, b.u.n.
Osmosis: 80% of water reabsorption occurs in the PCT via osmosis
Transport Maximum: The maximum rate of transport for a substance that is secreted or reabsorbed via active transport (Tm)
B.U.N. & Creatinine: Waste products in the body & are efficiently secreted by the kidneys; elevation of either = impaired renal function.
A.D.H. (Anti-diuretic Hormone) Secreted from the posterior pituitary gland; influenced by serum osmolarity; increased osmolarity triggers release which decreases urine output which results in water retention.
GFR normal: 125 ml/min
Urine output normal: 60 ml/hr or 1 ml/min
Glomerular BP normal: 55mmHg
Bowman’s Capsule fluid pressure normal: -15mmHg
Osmotic Pressure normal: -30mmHg
Net Filtration Pressure normal: +10mmHg
Tm Glucose normal: 320 mg/min
Tm Creatinine normal: 16 mg/min
Plasma B.U.N. normal: 8-18 mg/dl
Plasma Creatinine normal: 0.6 – 1.2 mg/dl
Total Body Water: Males: 60%, Females: 55%, Newborns: 75%
Millimole (mmol) 1/1000 of a mole; glucose is sometimes measured in mmol/L
Milliequivalent (mEq) 1/1000 of an equivalent; The amount of an ionized substance that has eletrochemical binding power equal to one mole of hydrogen ions; Electrolytes, Cations, Anions are expressed in mEq.
Milliosmole (mOsm) 1/1000 of an osmole; One mole of osmotically active particles; Osmotic activity of blood & urine are expressed in mOsm; Glucose & proteins exert great osmotic influence.
Intracellular Cations & their normals: K+: 150 mEq/L; Mg+: 25 mEq/L; Na+: 15 mEq/L
Intracellular Anions & their normals: HPO4: 100 mEq/L; Pr: 60 mEq/L; SO4: 20 mEq/L
Plasma Cations & their normals: K+: 5 mEq/L; Ca++: 5 mEq/L; Na+: 140 mEq/L
Plasma Anions & their normals: CL-: 105 mEq/L; HCO3: 24 mEq/L
What is osmolarity: The physiochemical property of substances in a solution which determines osmosis.
Serum Osmolarity normal: 275 – 300 mOsm/L
Serum Osmolarity includes: Sodium, Glucose, B.U.N., certain proteins
Loop Diuretics (Lasix); Act by inhibiting tubular reabsorption of sodium, potassium, & chloride in the Loop of Henle; Fast & Powerful
Thiazide Diuretics: Act by inhibiting tubular reabsorption of sodium, potassium, & chloride in the Distal Convoluted Tubule; HCO3 is reabsorbed causing Metabolic Alkalosis; Less potent than Loop Diuretics.
Osmotic Diuretics (Mannitol): Large molecular substances that pass into the tubules through the glomerular membrane & are not reabsorbed; Pull a lot of fluid; Used for Tx of cerebral edema – reduce brain swelling & control seizures.
Aldosterone: An adrenal hormone that increases sodium reabsorption & potassium secretion in response to: hyperkalemia, hyponatremia, hypovolemia, & low CO
Henderson-Hasselbach equation: pH = pK + Log HCO3/H2CO3
What is the Anion Gap: Used to determine if the pt’s metabolic acidosis is caused by the accumulation of fixed acid, which ‘eats up’ HCO3, or by the direct loss of HCO3.
Anion Gap equation: Na+ – (HCO3 + CL)
Anion Gap ranges: Normal: 9-14 = losing HCO3; > 14 = Pt is making fixed acids
Causes of losing HCO3: Kidney failure(acute or chronic), severe diarrhea
Causes of making fixed acids: Lactic acidosis caused by shock or hypoxia, ketoacidosis from DKA/starvation, or aspirin O.D.
Poop =_____ & Puke = _____ Bicarb & Acid
What is the major cation & the major anions? Cation: Na+; Anions: HCO3- & Cl-
Question Answer
Location and shape of Kidneys Bean shaped. Behind peritoneal cavity, below diaphragm. Cephaled poles = T12, and Caudal poles = L3…RETROPERITONEAL
Anatomy of the Kidney Adrenal glands- hormones, Renal artery and vein, Ureters- urine to bladder
Components of the Kidney Cortex- DARK OUTER, Medulla- PALE INNER, Renal Pyramids- 8-12 converge in to the Papillary Ducts to Major and Minor Calyces make up the Renal pelvis
Blood Vessles of Kidney Renal Art, Interlobar Art, Arcuate Art, Interlobular Art, Afferent Arterioles, Glomerulus, Efferent, Peritubular Cap, Interlobular Vein, Arcuate V, Interlobar, V, Renal V
Nepheron functional unit of kidney. analgous to acinus
Glomerulus network of up to 50 parallel capillaries branch from afferent art.
Bowman’s Capsule C- shaped expanded end of renal tubule holds glomerulus. Function = FILTER
Nephron Components Glomerulus, Bowman’s Cap, Proximal tubule, Loop of Henle, Distal tubule, Collecting duct
2 Capillary Beds of Nephron Glomerular, Peritubular
Function of Glomerulus Ultrafilter of Blood. mean P 55
Function of Peritubular Capillary Tubular secretion, Tubular reabsorption
3 Processes of the Nephron Glomerular Filtration, Tubular Secretion, Tubular Reabsorption
Normal Glomerular Fitration Rate (GFR) 125ml/minute
Urine Output 60ml/hour or 1ml/minute
Glomerular Filtraion in relation to Pressure Glom BP 55mmHg, BowCap fluid P -15, Osmotic P -30 = NET FILTRATION PRESSURE 10mmHg
Glomerular Blood Vessels AFFERENT ART- constriction = Decrease GFR, dilate = increase GFR…EFFERENT ART- constriction = increase GFR, dilate = decrease GFR
Reabsorption of Renal tubules Out of Tubules and into Peritubular Cap…Glucose, Sodium, Calcium, Amino Acids
Secretion of Renal Tubules Out of Peritubular Cap in to Tubules….Creatinine
Water Transport of Tubular System Osmosis- 80% H2O reasbsorption occurs in Proximal Tubule via Osmosis. Glucose, Sodium and Chloride have strong influence
Transport Maximum MAX rate for a substance that is SECRETED or REABSORBED via active transport (TM)
TM of Glucose 320mg/min
TM of Creatinine 16mg/min
Tubular secretion of urea BUN Normal Plasma BUN 8-18mg/dL
Tubular Secretion of Creatinine Normal Plasma Creatinine 0.6-1.2mg/dL
AnitDiuretic Hormone (ADH) Secreted by Posterior Pituitary Gland, Influenced by Serum Osmolarity, Increase Osmol. triggers ADH release which DECREASES Urine output= WATER RETENTION
Total Body WATER Males-60%, Females 50%, Newborn-75%
MILLIMOLE (mmol) 1/1000 of a mole, molecular or atomic weight in milligrams
MILLIEQUIVALENT (mEq)IONIC Charge 1/1000 of Equivalent. Ionized substances. Electrolytes, Cations, anions
MILLIOSMOLE (mOsm) 1/1000 of osmole. How much solute you have in plasma. Glucose and Protein exert great osmotic influence
Major Intracellular Cations and concentration K-150mEq/L, Mg-25mEq/L, Na-15mEq/L
Major Intracellular Anions and conc. HPO4(Phosphate)-100mEq/L, Pr(Proteinate)-60, SO4(Sulfate)-20
Major Plasma Cations and conc. Na-140, K-5, Ca-5
Major Plamsa Anions and conc. Cl-105, HCO3-24
Anions Gap to see if metabolic imbalance. Sub HCO3 and Cl from Na and K. Normal = 10-20mEq/L
Clinical significance of Anion Gap if >22= METABOLIC ACIDOSIS
Normal Serum Osmolarity 275-300 mOsm/L
What determines Serum Osmolarity Sodium, Glucose and BUN
Loop Diuretics (LASIX)FAST AND POWERFUL inhibit reabsorption of Sodium, Potassium, and Chloride in Henle.
Thiazide Diuretics SLOWER Inhibit tubular reabsorption of Sodium, Potassium, and Chloride in distal tube. Bicarb is reabsorbed = METABOLIC ALKALOSIS
Osmotic Diuretics (MANNITOL) PULL a lot of fluid. Large molecular substance pass into tubules thru glomerular membrane and are not reabsorbed
ALDOSTERONE adrenal hormone- Increases Sodium reabsorption and Potassium secretion in response to Hyponatremia, Hyperkalemia, Hypovolemia, Decreased CO
Phosphate Buffer FAST, NOT LONG LASTING to prevent acidosis, gets rid of extra H ions by forming a salt
Ammonia Buffer SLOWER, LONG LASTING gets rid of extra H ions by forming a salt, synthesized in Renal tubules, effective for long term acidosis
Cause of Resp ACIDOSIS Central nervous system depression, anesthesia, sedative drugs, narcotic analgesics, barbituates, Restricive disorders like obesity and kyphoscoliosis, COPD
Causes of Resp ALKALOSIS Anxiety, Stimulant drugs, Pain, Stim of J receptor=rapid shallow breathing, Pain, Pulm. Vascvular disease, Athsma
Causes of Met. Acidosis Loss of Base/Bicarb, diarrhea, Renal tubular acidosis, Gain of Acid – Diabetic ketoacidosis, Lactic acid. alcohol keto.
Causes of Met. Alkalosis Increase in Base-Diuretic therapy, Loss of fixed acid- Severe vomitting, Naso suction
Question Answer
Role of Cerebral Cortex in regulation of ventilation Think CC=CC. Conscious Control of ventilation. Speech and singing
Mechanism of rythmic ventilation Dorsal Resp. Group (DRG), like the SA node of breathing
Identify the types of medullary respiratory neurons DRG, VRG. DRG= maintain normal breathing, VRG= during exercise or diseaseto activate the accessory muscles
Where is the apneustic center? Caudal pons(LOWER), boost inspiratory effort = “GASP”
Where is the pneumotaxic center? Cephalic pons(UPPER/HEAD), responsible for “Panting” , increased rate and tidal V
Where are the peripheral chemoreceptors? Aortic Arch and Carotid Sinus
Which nerve innervates the Carotid peripheral chemoreceptors? Glossophryngeal
Which nerve innervates the Aortic bodies? Vagus
Chemical stimulus of the peripheral chemoreceptors? LOW PO2 <60mmHg, LOW pH
Location of chemical chemorecptors? Ventiolateral= Front and sides, immersed in CSF
Stimulation of chemical chemorecptors? HIGH CO2, LOW pH
What is the normal ventilatory response to CO2? CO2 is the strongest stimuli to ventilation
Factors which affect vent response to CO2? Drugs depress the medullary center, Narcotics like heroin, Morphine, and Barbituates, Pent, and Sero. Also airway obstruction(COPD, athsma)
What is the vent response to hypoxemia? Ve increases, rate increases when PO2<60mmHg
Changes in vent response to hypoxia during hypercapnia? Hypercapnia augments hypoxic response
Changes in vent response to hypoxia during hypocapnia? Hypocapnia diminishes hypoxic drive
What is the vent response to acute reduction in pH? Ve increases, stimulates peripheral chemoreceptors
Significance of blood brain barrier and CPF Gases diffuse easily across and Ions need active transport/slow. CSF pH= 7.32=little buffer capability
Chronic Resp. Acidoiss HCO3 increases in CSF and central chemmorectors are made non-responsive, then the LOW PO2stimulate the peripheral chemorecptors creating a hypoxic drive
Ketoacidosis causes stimulation of both CC and PC causing Kussmaul’s brething patern(Big R, Big Vt), and PaCO2 drops into the 20s
Apneustic Breathing Gasping= sustained inspiratory maneuver from BRAINSTEM injuries
BIOT’s Breathing 10-20 seconds ofapnea followed by 3-5 identical volume breaths. NEURO pts/INCREASE ICP
Cheyne-Stokes Respiration “Crescendo-Decrescendo” pattern, HEART failure or servre brain damage
Kussmaul’s Breathing From KETOACIDOSIS, rapid, deep breathing
Proprioceptors sensory end organs in muscles, tendons, ligaments that are stimulated by increased movement associated with changing resp mechanics of lung and chest wall
What triggers the proprioceptors? Decreased lung compliance(edema, fibrosis, consolidation), Decreased chest wall compliance(acities, obesity), Increased airway resistance(secretions and broncospasm), exercise
Physiologial role of chest wall proprioceptors? Control feeling of dypsnea when chronic conditions are present from exercise or disease
3 Pulmonary Vagal sensory reflexes Pulmonary stretch receptors(Hering-Bruerer), Irritant, and Juxtapulmonary(J) receptors
Where are the pulmonary stretch receptors? Located in smooth muscles of conducting airways
What stimulates pulmonary stretch receptors? Increased lung V, decrease intrapleural P
What are the physiological response to stimulation of PSR? inhibit inspiration(to protect from hyperinflation), Bronchodilation, increased HR
Paradoxical Reflex of the Head in newborns when PSR stim. GASP, with subtle breath stack to create FRC
Where are the Irritant recptors? between the epithelium cells in the conducting airway
What stimulates the Irritant recptors? Dust, smoke, chemicals, or mechanical from foreign bodies
What are the pyhsiological responses to stim of Irritant receptors? Cough, broncoconstrition, hypernea, Laryngeal constriction=GRUNT on Exp.
Where are the “J” receptors located? within the pulmonary interstitium
What stimulates the “J” receptors? edema, emboli
What are the physiological responses to stim of “J” receptors? Rapid shallow breathing, GRUNT, tachypnea, hyponea
3 major fetal circulation shunts Ductus Venosus, Foramen Ovale, Ductus Arteriosis
Ductus Venosus communicates the umbilical vein with the IVC
Foramen Ovale communicates the Right and Left Atria via one way valve, closes when cord is clamped and Right atrial P drops as IVC blood flow drops
Ductus Arteriosis communicates the pulmonary artery with the descending aorta, closes as PVR drops and levels of PGE1 drops and PaO2 increases >60mmHg
What are cardiopulm. adaptive changes in high alt. dwellers? increased lung size, polycythemia due to hypoxemia=erythropoetin from kidneys to stim bone marrow to make more RBC
Normal pulmonary adaptive changes during exercise increased Ve, increased aveolar ventilation(up to 65% MBC), increased diffusion x3
Normal cardiovascular adaptive changes during exercise increased O2 comsuption, increased ER, decreased SvO2 as more go to tissues, increased C(a-v)O2, increased HR x 200%, CO reaches 90% max
Benefits to cardiopulmonary training increased SV, lower rest HR, increased muscle strength, decreased myocardial and respiratory O2 cost
What altered resistive and elastic forces increase WOB? Increased resistance, decreased compliance, decreased conductance, decreased elastance
normal value of WOB 0.5 joules/L
Define and state normal value for oxygen cost of breathing O2 consupmtion of resp. muscles <5% of total O2 consumption(12ml/min)out of 250
Increased O2 cost of breathing is from ? increased resistance, decreased compliance, decreasedconductance, decreased elastance, empysema is too elastic but uses 120ml/min O2 consumption=almost 1/2