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A&P Fall 2023 > A&P Final Lecture 6 Notes > Flashcards

A&P Final Lecture 6 Notes Flashcards

1
Q

What cell is the governing body for potassium homeostasis in the body ?

A

Principle cell

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2
Q

What cell is the governing body for acid / base homeostasis in the body ?

A

Intercalated cells

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3
Q

What form does the protons show up in the urine

A

NH3

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4
Q

What is the most potent diuretic on the market

A

Loop diurectics
Furosemide

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5
Q

What are the 2 effects that the loop diuretics have on the renal tubules ?

A

Inhibiting Ion reabsorption
(Na)

Impact the concentration of renal interstitial concentration gradient

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6
Q

True or false, The urine osmolarity of a healthy person in the desert would be 300 ml per osmol

A

False,

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7
Q

True or false, Normally the kidneys has a concentrated renal interstitial concentration gradient

A

False, diluted renal interstitial concentration gradient

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8
Q

What is the big component of the renal interstitial concentration?

A

Urea

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9
Q

what is the charge that attract urea in the interstitial space

A

positive charge

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10
Q

Why is the urea concentration increased as the filtrate move down the renal tubules ?

A

Proximal tubules reabsorb some, however since the urea is larger the urea is not reabsorbed at the same rate as water, so the concentration increase has the urea move down the tubular

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11
Q

Most of Urea tends to be reabsorbed in what location of the tubules with the aid of what hormone?

A

MCD,

ADH (AVP)

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12
Q

Where is ADH release from? what cells does it effect in the kidney?

A

posterior lobe of the pituitary gland

Principles cells
Intercalated cells

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13
Q

What hormone affects the Aquaporins -2 and Urea Transporters ?

A

ADH/AVP

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14
Q

What side of the cell wall does ADH moves Urea transporters and Aquaporin -2?

A

Apical side

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15
Q

What are the 2 main concepts a student need to know regarding Urea ?

A
  1. Urea is reabsorbed at the proximal tubules with water but at a slower rate
  2. The increase in urea permeability in the MCD to allow urea to be reabsorbed
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16
Q

What happen to the blood as it descends the Vasa Recta ?

A

It becomes more concentrated

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17
Q

What happen to the blood as it ascends the Vasa Recta?
and Why?

A

It becomes more diulted

the solutes are able to move back into interstitium due to the current of the blood

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18
Q

Does the velocity of the blood plays a role in the amount of solute reabsorbed back in to the interstitium?

A

Yes, the slower the velocity of the blood the more concentrated the interstitium. it can move out of the peritubular capillaries and into the intersitium

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19
Q

Decrease in GFR = ________ renal blood flow = ________ = urinary output

A

decrease
decrease

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20
Q

What does the ADH system regulate

A

our blood osmolarity, excellular fluid

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21
Q

What will happen to the osmoreceptor cell in a hypertonic environment?

How do that effect the release of ADH?

A

the cell will shrink

increasing the release of ADH from the posterior lobe of the pituitary gland

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22
Q

What will happen to the osmoreceptor cell in a hypotonic environment?

How do that affect the release of ADH?

A

the cell will swell

decreasing the release of ADH from the posterior lobe of the pituitary gland

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23
Q

How do the osomoreceptor determine the amount of ADH that needs to be release

A

by selectively reabsorption of water

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24
Q

Which hormone has a direct effect on the fluid in the body?

A

ADH

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25
Q

What are the names of the 2 neurons where the osomreceptors synapse on that is responsible for the production of ADH?

A

anterior -superaoptic neuron (nuclei)

posterior - Paraventricular neuron

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26
Q

Where is the osomoreceptor found within the body

A

anterior portion of the thalamus

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27
Q

How much production of ADH is the Supraoptic neuron responsible for?

A

5/6

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28
Q

How much production of ADH is the Paraventricular neuron responsible for?

A

1/6

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29
Q

True or False, Both production of ADH travels separately in the neuro - hypothesis

A

False, ADH travels together in the neuro - hypothesis

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30
Q

True or False, Very rich vascular beds located near the posterior pituitary lobe

A

True

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31
Q

What area of the renal tubules where the ADH is most effective

A

MCD

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32
Q

What effect does ADH have on the renal interstitium in correlation to effecting the serum osmolarity

A

Changes the renal interstitium space osmolarity

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33
Q

How do changes in the renal interstitium space effect osmolarity in the urine?

A

it can make out urine more or less concentrated depending on its osmolarity

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34
Q

Under a steady state, what is the minimum osmolarity concentration of filtrate in the loop of henele can be with a decrease release of ADH?

A

600 mOsm/L

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35
Q

What happens to the urine when there is no release of ADH?

A

very diluted

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36
Q

What is the maximum osmolarity concentration of the filtrate in the loop of henele with an increase release of ADH?

A

1200 mOsm/l

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37
Q

What happens to the urine when there is a release of ADH?

A

Very concentrated

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38
Q

What is the pathway of decreasing water excretion involving ADH?

A
  1. Water deficit
  2. Increase extraceullar Osmolarity
  3. Osmoreceptors sense a change in the environment
  4. increase ADH secretion from the posterior pituitary gland
  5. increase Plasma concentration ADH
  6. Increase in water permeability in distal tubules and collecting ducts (MCD)
  7. increase water reabsorption
  8. Decrease water excretion
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39
Q

What laboratory electrolyte is a reflects the osmolarity concentration in the body

A

sodium

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40
Q

What does free water clearance means

A

it gives us an idea on how much free water we are getting rid of

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41
Q

Alot of ADH = __________ water clearance
low amount of ADH = __________ water clearance

A

low water clearance
high water clearance

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42
Q

What happens to the blood osmolarity if ADH is block?

A

it becomes irregular, concentrated

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43
Q

True or false a person with diabetes and blocked ADH do not have life threading problems

A

False, it becomes irregular and unstable

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44
Q

What other sensors around the body that can influence ADH?

A

Baroreceptor cardiopulmonary receptor
-looking at Blood pressure in the artery
low pressure sensors in the heart and veins
- looking at the blood volume

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45
Q

What is the disease process that inhabits the secretion of ADH?

A

Diabetes insipidus

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46
Q

Identify and define the 2 types of Diabetes Indipidus?

A

Central Diabetes insipidus
- lack of release of ADH
Nephorgenic Diabetes insipidus
-failure of kidney to respone normally

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47
Q

What can cause Nephogenic Diabetes insipidus?

A

infection
drug (high doses of lithium)
inherited diseases
ETOH

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48
Q

What can cause Central Diabetes insipidus

A

brain damage
trauma
storke
drugs
ETOH (reduce the amount of ADH release from the posterior pituitary gland)

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49
Q

What is the half life of ADH, and why?

A

20mins, which allows us to rapidly adjust to changing positions

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50
Q

What stimulates the increase in the thirst controllers?

A

-increase in plasma osmolarity
-decrease blood volume
-decrease blood pressure
-increase Angiotensin II
-Dryness of mouth
-decrease of ADH

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51
Q

What stimulates the decreases in the thirst controllers ?

A

-decrease in plasma osmolarity
-increase blood volume
-increase blood pressure
-decrease angiotensin II
gastric distention

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52
Q

What are the 2 hormones responsible for thirst control?

A

ADH
Angiotensin II - something must be driving it

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53
Q

How do a lot of gastric distention affects the thirst controllers?

A

decrease thrist

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54
Q

Craving to eat salty food is due to a ________ in the thirst control.

Which hormone is affected

A

increase

Angiotensin II

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55
Q

What cause a decrease in ADH release?

A

-decrease osmolarity
- increase in blood volume
- increase in blood pressure
-Drugs:
-ETOH

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56
Q

What cause an increase in ADH release?

A

-increase plasma osmolarity
-decrease blood volume
-decrease blood pressure
-nausea
-hypoxia

-Drugs:
Morphine (not strong)
Nicotine
Cyclophosphamide

57
Q

Describe how potassium homeostatsis is maintain?

A
  1. increase in potassium intake
  2. increase in potassium concentration
  3. increase in aldosterone
  4. increase in potassium secretion out the CCD in the princple cell
  5. potassium secretion
58
Q

What is the hormone that affect the potassium plasma concentration

A

Aldosterone

59
Q

What will happen if we use aldosterone antagonist or a Na channel blocker

A

we would have swings in our potassium concentration in the body

60
Q

True of false, overall in the past we had a large sodium intake

A

True

61
Q

Lower potassium diet = _____ potassium secretion

A

low

62
Q

What is the disease that is due to an over active adrenal gland, causing excess amount of aldosterone

A

conn’s disease

63
Q

What are the hormones that the kidney alternates to maintain balance

A

some ADH, Angio II and aldosterone

64
Q

High potassium diet = _______ aldosterone

A

high

65
Q

Problems with high Aldosterone

A

long term decrease production in potassium

66
Q

What is the disease of lack of adrenal gland function

A

Addison’s

67
Q

what affects would addison have on potassium levels

A

-sustained elevation potassium levels

-acid/ base inbalance

68
Q

what drug can be given to treat Addison

A

-potassium sparing diuretic
-non - potassium sparing diuretic

69
Q

What are ways in handling: sodium Connection?

A
  1. increase in sodium intake
  2. increase in GFR
  3. decrease reabsorption of Na in proximal tubular will have an effect of increasing Na in distal tubular flow
  4. decrease Aldosterone and increasing distal tubular flow leads to unchange K excretion
70
Q

True or false, Blocking aldosterone system or Angio II does not have that much affect on the sodium concentration

A

True

71
Q

What does a healthy kidney do in regards to small amount of changes regarding the arteriole blood pressure ?

A

any increase in pressure will be brought back down by the kidneys,

any decrease pressures long term should be corrected by the kidneys with fluids or electrolytes

72
Q

True or False, in an acute setting increase BP will increase urine output

A

True

73
Q

What does it say about our kidneys: If we have different pressures or blood pressure is sensitive to salt intake.

A

something is wrong with the kidneys

74
Q

what is salt induce HTN?

A

a salt induce increase in blood pressure

it is reversible
depends on the salt inake

75
Q

What is central HTN?

A

set point that is a higher number
- reason why is likely kidney problem trying to determine what the actually BP is due to some type of obstruction between blood vessels of the kidney and the heart
-if it is measuring blood pressure on the other side of the obstruction it is going to be low
- kidney will hang on to volume and electrolytes until it thens that the BP is higher

76
Q

What would cause the kidney to think that the BP was low in central HTN and what hormones are affected?

A

A stanatic blood vessels

increase in renin
increase in Ang II

77
Q

What causes HTN

A

Something at the kidney

78
Q

True or False, We remove a portion of our ECF when treating HTN with diuresis?

A

True

79
Q

How much volume is in the ECF?

A

14L

80
Q

How much volume in the ICF?

A

28L

81
Q

What affects does the diuretic has on the urine output and ECF on the first day

A

large urine output
ECF volume is reduce

82
Q

reduce ECF volume = _________ Plasma volume

A

reducing

83
Q

What happens after a couple of days of diurectic thearpy ?

A

the Patient return to normal with a little less ECF

84
Q

How do you determine if the diuresis is effective

A

looking at the BP

85
Q

If the diuretic is not effective on decreasing the BP what other ways can you improve decreasing BP?

A

increase dose of diuretic or add more medication

86
Q

What would happen to a healthy person that drinks a liter of pure water?

A

blood osmolarity will drop
- water is reabsorb in the small intestine
- small change in the blood osmolarity will cause a decrease in the ADH being release
- urine output increase

87
Q

What happen to the amount of solutes that we get rid of after drinking pure water?

A

solute excretion rate does not increase with the water excretion rate, because ADH

88
Q

What will happen once our body diuresis the water?

A

it goes back to homeostasis

89
Q

Renal drugs: Antihypertenisve

Mannitol

A
  • osmotic diuretic
  • if it gets filitered into the proximal tubule but not reaborbed
  • less osmosis happening
  • increasing the fluid in the tubules
90
Q

Renal drugs: Antihypertenisve

Acetazolamide

A
  • Carbonic Anydrase inhibtor
  • interfers with the sodium reasborption that happen
  • as we are secreting protons out the NHE pump
  • increasing urine output
91
Q

Renal drugs: Antihypertenisve

ARB’s

A
  • blocks Angiotenins type 2 receptors
92
Q

Renal drugs: Antihypertenisve

ACEi’s

A
  • reduce the formation of Ang I to Ang II
93
Q

Renal drugs: Antihypertenisve

K+ Sparing Diuretics

A

-Anything that interfers with role of aldosertone
-anything that increase the sodiem deliver to the distal tubules

94
Q

Renal drugs: Antihypertenisve

Renal aterial stenosis

A
  • something that blocks the renal Ango II system
95
Q

Renal drugs: Antihypertenisve

Loop Diuretics

A

-powerful diuretic

96
Q

Renal drugs: Antihypertenisve

Thiazide Diuretics

A
  • they are able to mess with the calicum homostatis
97
Q

Renal drugs: Antihypertenisve

CCB’s

A
  • Anything that relaxes blood vessles increase renal blood flow, increase UOP
98
Q

Renal drugs: Antihypertenisve

No Donors

A

Anything that relaxes blood vessles increase renal blood flow, increasing UOP

99
Q

Renal drugs: Antihypertenisve

Catecholamine Anatagonist

A
  • Example: beta blocker
    -dilates the afferent ateriaoles, which increase renal blood flow and GFR = increasing UOP
100
Q

MAP, renal blood flow

what outcomes would you see in a disease kidney and normal kidney when given a vasopressor?

A
  • low purfuse kidney due to disease (Chronic low)
  • given a pressure will increase purfusion to the kidney ( increasing UOP)
    - vasocontriction in the other vessels is what is improving renal blood flow not so much the Afferent arterioles

-giving a pressue to a normal BP you will not see alot of UOP

101
Q

Which section of the nephrons is less well autoregulated, is most sensitive to the changes in blood flow, and the first to go in kidney damage?

A

M. Nephrons

102
Q

True or false, Not having a well manage autoreulation is a key component in the kindey function?

A

True
-allows us to manage how concetated our renal interstital sapce is
-what kind of change will expect to see in GFR and UOP when we have increase in BP

103
Q

Which nephons is well autoregulated,

A

C. Nephrons

104
Q

How do diabetes affect the nephrons?

A

excess sugars to bind to everything
causing the immune to destroy stuff
causeing inflammtion

105
Q

how do diabetes affect the nephron filitration?

A

filitration change due to uncontrol blood sugar

106
Q

Where is glucose reasbored with what electroylete

A

Glucose is reabsorbed in the proximal tubule

with sodium

107
Q

True or false, If we have more glucose reasborbed we will have more sodium reasorbed

A

True , due to the 2nd set of transporters

108
Q

True or false, If more sodium is reabsorbed at the proximal tubules it will affect the concentation at the distial tubules

A

True

109
Q

Descibe the pathway that takes place at the Macula Densa with low NaCl due to DM?

A
  1. Macula densa senses a decrease in NaCl
  2. increasing Renin realse
    2a. incresing Ang II
  3. increasing Efferent arteriolar resistance and decreaseing afferent arteriolat resistance
  4. increasing GFR (125ml/min)
110
Q

What are the 2 problems with DM that cause kidney damage

A
  1. inflammatory process
  2. over worked
111
Q

Why is a high protein diet has smiliar affects like DM dealing with na

A
  1. proteins breaks down to amino acids
  2. amino acids are co- reabsorb with sodium like high glucose
112
Q

Postitive feed back cycle

Describe the pathway of renal disease/ failure as describe in lecture

A
  1. Primary kidney disease
  2. decrease in the nephron number
    3a. Hypertrophy and vasodilation of survivng nephons
    3b. increase in arterial pressures
  3. increase in the Glomerular pressures and or filtration
  4. Glomerular scierosis
113
Q

What is the classification of chronic renal failure

A

< 20 -5% GFR

114
Q

What is the classification of renal insufficiency

A
  • 50 - 20%
115
Q

What is the classification of End - Stage Renal Disease (ESRD):

A

< 5%

116
Q

At what age do you start loosing nephorns if you are healthy

A

40 year old

117
Q

What are 4 thing that must be restricted for a person that is in renalfailure?

A

Na
Volume
K
Proteins

118
Q

How do NSAIDs affects the renal function?

A
  • reduce prostoglandins that is need for kidney function
119
Q

What are some of the problems are you expected to see with renal failure?

A

Hypernatremia
Hypervolemia
Hyperkalemia
Hypertension
Hypocalcemia
Uremia (Azotemia)
Acidosis
Anemeia
Hyperphosphatemia

120
Q

Body Fluid Compartments, 70kg

What is the total amount of fluid found in the body
what is the amount in the excellular
what is the amount in the intracellular

A

amount of fluid 42L
1/3 - ECF (14L)
2/3 - ICF (28L)

121
Q

Body Fluid Compartments, 70kg

What is the osmolatity between the 2 comparments?
How do is the osmolarity maintain

A

300 mOsm/L

water will move across the permable membrane to maintain the balance ?

122
Q

Body Fluid Compartments, 70kg

True or False: Sodium, and Potassium move freely across the cell wall like water

A

False, Sodium,and Potassium do not move freely across the cell wall

123
Q

Body Fluid Compartments, 70kg

What would happen to the compartments if we gave an Isotonic solution to a patient?

What is an example of a isotonic solution?

a fluid is similar to the body’s normal balance

A

-0.9 NaCl
- adding salt and water to the blood should stay in the ECF

124
Q

Body Fluid Compartments, 70kg

What would happen to the compartments if we give a hypertonic solution to a patient?

What is an example of a hypertonic solution?

a fluid that is a little over the body’s normal balance

A

3% NaCl
-adding extra salt (disproportional amount) and water to ECF
-increasing the osmolarity of the ECF fluid compartment (making it more salty)
-movement of water form ICF to correct the increase of the salt in the ECF (increasing the ECF volume)
-water shift making the volume balance in each compartment

ECF volume increase
ICF volume decrease
Osmolarity increase

125
Q

Body Fluid Compartments, 70kg

What would happen to the compartments if we give a hypotonic solution to a patient?

What is an example of a hypotonic solution?

a fluid that is little over the body’s normal balance

A
  • 0.45 NaCl
  • adding small amount of salt ( Half the amount of 0.9) and water
  • lowering the osmolarity
  • shifting water from ECF to the ICF

ICF volume increase
ECF volume decrease

Overally osmolarity of the system to be lower

126
Q

What is a concern with hyponatremia?

A

increasing intercranial pressures

127
Q

What are the tubular Substance Handling

Glucose (g/day)

Amount Filtered, Amount Reabsorbed , % of filtered load Reabsorbed

A

Amount Filtered - 180
Amount Reabsorbed -180
% of filtered load Reabsorbed -100%

128
Q

What are the tubular Substance Handling

Bicarbonate (mEq/day)

Amount Filtered, Amount Reabsorbed , % of filtered load Reabsorbed

A

Amount Filtered - 4320
Amount Reabsorbed - 4318
% of filtered load Reabsorbed - >99.9%

129
Q

What are the tubular Substance Handling

Sodium (mEq/day)

Amount Filtered, Amount Reabsorbed , % of filtered load Reabsorbed

A

Amount Filtered - 25,560
Amount Reabsorbed - 25,410
% of filtered load Reabsorbed - 99.4 %

Amount excreatd 150 (increase in intake will excreate more)

130
Q

What are the tubular Substance Handling

Cloride (mEq/day)

Amount Filtered, Amount Reabsorbed , % of filtered load Reabsorbed

A

Amount Filtered - 19,440
Amount Reabsorbed -19260
% of filtered load Reabsorbed -99.1%

for the amount in the blood, we excreate a significant amount

131
Q

What are the tubular Substance Handling

Potassium (mEq/ day)

Amount Filtered, Amount Reabsorbed , % of filtered load Reabsorbed

A

Amount Filtered -756
Amount Reabsorbed- 664
% of filtered load Reabsorbed - 87.8%

get rid of most of the potassium by excreation in the princple cells

132
Q

What are the tubular Substance Handling

Urea (g/day)

Amount Filtered, Amount Reabsorbed , % of filtered load Reabsorbed

A

Amount Filtered - 46.8
Amount Reabsorbed -23.
% of filtered load Reabsorbed - 50%

recycle itself within the kidney to concentrated the intersitium

133
Q

What are the tubular Substance Handling

Creatinine( g/day)

Amount Filtered, Amount Reabsorbed , % of filtered load Reabsorbed

A

Amount Filtered - 1.8
Amount Reabsorbed -0
% of filtered load Reabsorbed -0

134
Q

Sodium cannot move across the capillaries free at what barrier in the body?

A

Brain

135
Q

What problem would concern a CRNA with a patient that is taking ARB’s?

A

response to the body during hemorrhage
blood loss
low blood presue

RAAS place a big role on the body ability to hang on to fluids, electro., and vasocontricts.

136
Q

What would happen to a blood pressure after a hemorrhage with an intact RAAS?

A

They are able to maintain a moderate BP with the blood loss

137
Q

What would happen to a blood pressure after a hemorrhage without RAAS?

A

They are not able to maintain a moderate BP with the blood loss

patient is on ARB’s

138
Q

What life style choice would affect the RAAS?

A

poor diet, high in Na

suppressing the RAAS system
by suppressing renin release at the MD at the distial tubules

potato chips

A&P Fall 2023 (7 decks)

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