Exam 3 Review Flashcards
(238 cards)
1
Q
Name 4 things the kidneys excrete?
A
Urea
Creatinine
End products
Metabolites
2
Q
Name 6 things the kidneys regulate?
A
waste
BP
acid/base
Electrolytes
Hormones
Water
3
Q
Name the layers of the kidneys from superficial to deep
A
capsule
cortex
medulla
pelvis
4
Q
Kidneys get ____ of your CO
A
22%
5
Q
The renal artery splits into ____, ___ and _____
A
interlobar
arcuate
interlobULar
6
Q
Where can you find the peritubular artery?
A
around the tubules
7
Q
What are the two types of capillary arteries?
A
Glomerular and peritubular capillaries
8
Q
In the glomerular artery, is the hydrostatic pressure high or low/
A
high hydrostatic pressure
9
Q
If you increase flow into the afferent glomerular capillary, what happens?
A
GFR increases
10
Q
What is the order of flow through the nephron
A
-Bowman’s capsule/glomerulus
-Proximal tubule
-Loop of Henle (thin, thin, thick)
-Macula Densa
-Distal Tubule
-Cortical collecting tubule
-Medullary collecting tubule
-Collecting duct
11
Q
What are the two types of nephrons?
A
juxtamedullary and cortical nephrons
12
Q
Cortical nephrons are ____
A
common
13
Q
What is the responsibility of the juxtamedullary nephron?
A
concentration of urine
14
Q
Which type of nephrons have vasa recta?
A
juxtamedullary nephrons
15
Q
**What is the formula for urinary excretion
A
excretion = filtration - reabsorption + secretion
16
Q
Define filtration
A
out of capillaries into bowman’s capsule
17
Q
define reabsorption
A
from the Bowman’s capsule to the peritubular capillaries
18
Q
Define secretion
A
out of the capillaries into the tubules
19
Q
_____ is 100% filtered
A
creatinine
20
Q
_____ are initially filtered but then get reabsorbed partially
A
electrolytes
21
Q
What two substances should you remember together?
A
Amino acids and glucose
22
Q
what 3 main end products are excreted?
A
urea
uric acid
creatinine
23
Q
a high GFR will (increase/decrease) removal of waste
A
increase
24
Q
how many liters of plasma in your body?
A
3 Liters
25
At a normal GFR how many liters can your body filter in one day?
180 Liters
26
Kidneys filter your plasma _____ in one day
60X
27
What two things does filtrate NOT contain?
proteins or RBCs
28
The GFR represents _____% of your renal plasma flow
20
29
The glomerular capillary membrane is (negatively/positively) charged. What layer?
negatively charged
endothelium
30
What is the job of the glomerular capillary membrane?
prevents proteins from crossing
31
What are the 3 layers of glomerular capillary membrane?
endothelium
basement membrane
epithelium
32
Which layer of the glomerular capillary membrane has the large holes in it?
basement membrane
33
Which layer of the glomerular capillary membrane has podocytes?
epithelium
34
What three substances have the same filterability as water?
sodium
glucose
insulin
35
What three components make up the GFR? What is the net filtration pressure?
Glomerular hydrostatic pressure (60)
Bowman’s Capsule Pressure (-18)
Glomerular colloid osmotic Pressure (-32)
10
36
The Glomerular hydrostatic pressure is ____
(60)
37
Bowman’s Capsule Pressure is ___
(-18)
38
Glomerular colloid osmotic Pressure ____
(-32)
39
When the filtration coefficient is low, the GFR (increase/decreases)
decreases
40
kidney stones are a result of an (increased/decreased) bowman's capsule pressure, and GFR (increases/decreases)
increased bowman's capsule pressure
so GFR decreases
41
When the afferent arteriole dilates, what happens in terms of blood flow and GFR
increased blood flow, and GFR increases
42
Decreased GFR can be a result of what conditions?
less blood flow
lower filtration coefficient
kidney stones
CKD
HTN
43
Less blood flow is due to afferent (dilation/constriction) and/or efferent (dilation/constriction)
afferent constriction
efferent dilation
44
What two hormones decrease GFR?
norepinephrine and epinephrine
45
Sympathetic stimulation (increases/decreases) GFR
decreases
46
Renal artery pressure is the same as ?
systemic arterial pressure
47
resistance is determined by what 3 arterioles?
interlobULar
afferent/efferent
48
T/F: Kidneys regulate their own renal blood flow
TRUE
49
Angiotensin II ____ both afferent and efferent arterioles. Which one does it exert the greatest effect?
constricts
mainly EFFERENTS
50
Angiotensin II (increases/decreases) GFR and (increases/decreases) renal blood flow
increases GFR
decreases renal blood flow
51
what is the MOA for Ace inhibitors? What is the end result on BP and GFR?
prevent AT1 from converting to AT2
lowers BP and lowers GFR
52
The macula densa is most receptive to ____ concentration
sodium chloride
53
the macula densa controls ______ and _____
renal blood flow and GFR
54
Macula densa affects the (afferent/efferent/both) arterioles
both
55
If the macula densa senses low sodium, what happens?
it will dilate the afferent arterioles and release renin
56
if the afferant arterioles is dilated the GFR will be (higher/lower)
higher GFR
57
In a higher GFR, (more/less) sodium filtered so that you can reabsorbed (more/less) later
more sodium
more
58
What effect does renin have? Does the GFR increase or decrease
constricts Efferent arterioles
GFR increases
59
What is the flow chart look like for GFR regulation. Draw it
60
Which is more important, reabsorption or secretion?
reabsorption is more important
61
____ and ____ are poorly absorbed, so they will be present in urine
urea and creatinine
62
What are the top two electrolytes that are reabsorbed?
glucose and bicarb
63
What does transcellular mean?
across the cell, aka through it
64
What does paracellular mean?
next to cell, aka between two cells
This is going through "tight junctions"
65
where does ultrafiltration/bulk flow occur?
out of the lumen of the nephron and in between the capillaries and tubules
66
active transport requires ____
ATP
67
Secondary active transport requires ____
glucose
68
What is the most important ATPase pump?
sodium/potassium ATPase pump
69
what are the two glucose co-transporters?
SGLT2 and SGLT1.
70
Which glucose co-transporter does the bulk of the glucose? where is it located?
SGLT2
proximal convoluted tubule
71
the SGLT co-transport system is what kind of transport? What is the primary part?
secondary transport
sodium is the primary part
72
Counter transport helps to ???
preserve energy
73
Sodium passively diffuses from _____ into _____
lumen
tubular cell
74
sodium is actively transported from _____ to _____
tubule cell to blood.
75
When sodium is coming in via counter transport, it can spin the door so ____ ions can leave. no energy required
Hydrogen
76
Once you hit your reabsorption max, you ____ the rest
excrete
77
_____ is the max reabsorbable load for glucose
375 mg/min
78
T/F: If substances are passively absorbed, they have a transport maximum.
False!
passively absorbed substances are time dependent
79
What is another name for time dependent transport?
gradient-time transport
80
What is the exception for passive absorption?
sodium reabsorption
81
Bulk of Na and water is reabsorbed in the _____
proximal convoluted tubule
82
Besides water and sodium, ___, ____ and ____ are also reabsorbed in the PCT
bicarb, glucose and amino acids
83
In the PCT ______ and _____ increase in concentration
urea and creatinine
NOT reabsorbed at all in the PCT
84
What is important about the descending LOH reabsorption?
EXTREMELY permeable to water
aka the water is leaving
85
The ascending LOH is (highly/not at all) permeable to water
0% permeability to water
86
_____ leaves at the ascending LOH. What does this result in?
sodium
concentrated urine, LOTS of reabsorption happens here
87
Where do loop diuretics work? What transporter is involved?
Ascending LOH
1Na-2Cl-1K transporter.
88
The macula densa is located where?
first part of the distal tubule
89
What is happening at the distal tubule?
Dilutes urine, aka reabsorbing the rest of the ions like Sodium-Chloride, Bicarb, and Calcium
90
The distal tubule is impermeable to ____ and ____
water and urea
91
Where do thiazide diuretics work?
distal tubule
92
principal cell are responsible for ___ and ____ into the blood, and ____ out
sodium and water
potassium out
93
intercalated cells are responsible for ____ in and ____ out
K and bicarbonate are reabsorbed
Hydrogen excreted out
94
Principal cells are where _____ and ______ work (types of medication)
aldosterone antagonists and sodium channel blockers
95
_____ is the final determinant of urine concentration
Medullary collecting duct
95
____ is the only site where ADH works
Medullary collecting duct
96
_____ is the only place urea is permeable
Medullary collecting duct
97
The higher the ADH, the more ____ reabsorbed
water
98
_____ + ____ = concentrated urine
High ADH + Hyperosmotic renal medulla
99
Describe the process of the countercurrent mechanism
1. There is only one place in the loop of Henle that is permeable to water: descending loop.
2. Essentially, in the ascending loop, you just keep pumping solutes into the medulla (outside)
3. When new filtrate flows into the descending loop, it pushes water out to dilute the medulla (outside)
4. As this process repeats you are left with a hyperosmotic medulla, since water can only flow into the medulla at the descending loop.
5. The entire time, the medulla cannot send solutes back into the loop. It is a one way street.
6. The main solute that makes the medulla hyperosmotic is urea. (requires ADH)
100
Medullary blood flow is very (fast/slow) so the solutes don’t flow away via ____
slow
blood
101
Describe the role of the Vasa Recta in countercurrent multiplier
Because the medulla is so concentrated with solutes, some it flows into the Vasa Recta.
However, this makes it hyperosmotic as it continues to gain solute but lose water.
As it goes up the loop, the Vasa Recta is permeable to water unlike the loop of Henle, so it reabsorbs water and gets rid of solute (aka undoing what happened in the beginning).
This ensures that all the hard work of concentrating the medulla via the loop of Henle is not lost.
Blood gets hyperosmotic as it descends, but it is reversed as it ascends, so pretty much nothing changed and no solute is lost.
102
What is the main cause of prerenal acute renal failure?
hypoperfusion
103
What is the main common cause of intrarenal acute renal failure?
abnormalities of vessls or glomeruli
104
what is the main common cause of postrenal acute renal failure?
Kidney stones
105
Acute renal failure can lead to _____ and _____
hyperkalemia and metabolic acidosis
106
What are the top 3 main causes of prerenal acut renal failure?
1. Volume depletion
2. Cardiac Failure
3. Peripheral vasodilation/shock
anything that causes not enough blood flow to kidneys or not enough pressure to get blood to the kidneys
107
is prerenal acute renal failure reversible?
Reversible, unless renal blood flow is < 25%
108
How do the kidneys adjust in prerenal acute renal failure?
temporarily slowing GFR
109
Give some examples of glomerular capillary/vessel damage
What type of acute renal failure?
Vasculitis, cholesterol, acute glomerulonephritis (GN)
intrarenal
110
Give an example of renal tubular epithelium damage
What type of acute renal failure?
Acute tubular necrosis (ATN)
intrarenal
111
Give two examples of renal interstitium damage
What type of acute renal failure?
Acute pyelo (UTI going up to the kidneys themselves)
Acute interstitial nephritis (drugs or immune)
intrarenal
112
What are three examples of postrenal acute renal failure?
Bilateral obstruction of ureters/renal pelvis due to clots or stones
Bladder obstruction
Obstruction of Urethra
113
In a male patient, what are two examples of postrenal acute renal failure?
Some sort of stone
prostate
114
At what point does it become visible that your nephrons are dying?
start showing signs of renal failure once you have lost 25% of them
115
What are the top 5 causes of ESRD?
DM
HTN
Infections
Vascular diseases
(Obesity plays a role in both DM and HTN)
116
As you start to lose nephrons, your kidney become _____
scarred
117
What is the most common form of kidney disease?
Nephrosclerosis
its is benign but irreversible
118
What chronic renal disease is immune complex mediated?
glomerulonephritis
119
What kind of nephrons have vasa recta?
juxtamedullary
120
What is the MCC of nephrotic syndrome in children?
minimal change disease
121
what is minimal change disease caused by? What is an obvious factor?
caused by damage to your glomeruli
protein will be present in the urine
122
Chronic renal failure is amplified by ____ and ______
HTM and DM
123
What is chronic glomerulonephritis?
It's characterized by irreversible and progressive glomerular and tubulointerstitial fibrosis, which can lead to a reduction in the glomerular filtration rate (GFR) and retention of uremic toxins
124
Myenteric plexus is also know as _____ plexus
Auerbach's plexus
125
Myenteric/Auerbach’s plexus is responsible for ????
GI movement/peristalsis
126
Submucosal plexus is also known as ____ plexus
Meissner's plexus
127
Submucosal/Meissner’s plexus is responsible for ???
Secretions/blood flow
128
Where is the primary parasympathetic cut off point?
transverse colon
129
Sacral parasympathetic is _____ to ____
transverse colon to anus
130
What transmitter excites the GI tract?
Acetylcholine
131
What transmitter inhibits the GI tract? What levels?
Norepinephrine
L5-T2??? need to double check this fact
132
Gastrin is secreted to break down ____
proteins
133
Where is gastrin found?
at the bottom of the stomach, G cells
134
What is the inhibitor of gastric emptying?
CCK
135
CCK is released in response to _____. What does it release?
fat
releases bile
136
______ secretes everything except gastric acid
secretin
137
______ inhibits gastric acid
gastric inhibitor peptide (GIP)
138
GI blood flow uses ____ circulation
splanchnic
139
GI blood flow flows through the ______ on return
portal vein
140
_____ and _____ get absorbed earlier than fats
carbs and proteins
141
What are the two main arteries off the aorta?
Which one is most important?
**Superior mesenteric artery and Inferior mesenteric artery
142
_____ are the functional unit of the liver
lobules
143
What is the order of liver blood flow?
1. Portal veins
2. Sinusoids
3. Central veins
4. Hepatic veins
5. IVC
144
_____ cells eat toxins/bacteria as the blood flows through them. (aka the detox part of your liver.
Kupffer cells
145
food + gastric secretions =
chyme
146
The _____ is the end of the stomach, and it prevents you from dumping your entire meal into your intestines immediately.
pylorus
147
What are the two different types of gastric glands?
Chief cells
parietal cells
148
____ cells are associated with pepsin
chief cells
149
parietal cells are associated with ____ and _____
HCl and intrinsic factor
150
pyloric glands mainly just secrete ____
gastrin
151
The presence of _____ specifically is one of the indicators for your duodenum to slow gastric emptying. What two hormones are associated with it?
fats
CCK and GIP
152
The pancreas functions as both ????
an endocrine and exocrine gland
153
acini cells are associated with ____
bicarb
154
The pancreas is associated with _____, ____ and _____ that break down proteins
trypsin + chymotrypsin + carboxypolypeptides
155
trypsin + chymotrypsin + carboxypolypeptides all start out as _______. What changes that?
inactivated
are activated by the HCl in the stomach acid
156
What enzyme is associated with breaking down carbs?
pancreatic amylase
157
What 3 pancreatic enzymes are responsible for breaking down fats?
Pancreatic lipase + Esterase + Phospholipase
158
How does the SI increase surface area?
Valvulae Conniventes (3x)
Villi (10x)
Brush border Microvilli (20x)
total: 1000X increase in surface area
159
What are the three monosaccharides?
Glucose
Fructose
Galactose
160
Which simple sugar is the sweetest?
fructose
161
Which simple sugar is not found solo in nature? What is it always a part of?
galactose
lactose
162
What are the two components of sucrose?
glucose + fructose
163
What are the two components of lactose?
galactose + glucose
164
What are the two components of maltose? Where is it commonly found?
glucose + glucose
beer, cereals, germinating seeds
165
Which disaccharide is the least sweet?
Lactose
166
Which disaccharide is the most common?
sucrose
167
What are two common polysaccharides?
starch and glycogen
168
What are the TWO sources of amylase?
salivary amylase and pancreatic amylase
169
Hydrolysis is used for the breakdown of ______, _____ and ______.
COMPLEX carbs
polysaccharides
triglycerides to 3 FAs and glycerol
170
how are triglycerides broken down? what are the components? via what enzyme?
triglycerides to 3 FAs + glycerol
pancreatic LIPASE
171
emulsification happens via _____
bile acids
172
_____ + _____ = emulsified fat droplets
bile acids + agitation
173
emulsified fat + _____ = fatty acids and 2-monoglycerides
pancreatic lipase
174
once triglycerides are broken down, _____ are formed
micelles
175
Draw the diagram for protein digestion
176
When talking about lipoproteins, the density refers to ____
how much PROTEIN is in it
177
Which type of cholesterol is considered "bad"
LDL (has a low density of protein aka a high density of fats)
178
Which type of cholesterol is considered "good"
HDL
179
Where are most triglycerides stored?
as adipose cells or in the liver
180
What is achalasia?
hypercontractile lower esophageal sphincter
181
Name two causes of the peptic ulcer disease?
H. pylori infection
excess NSAID use
182
What are the two main causes of pancreatitis?
gallstones
binge drinking alcohol
183
non-tropical sprues = ______ disease. How does it work? How is it mostly commonly transmitted?
celiac disease
gluten kills the villi in the your SI
familial inheritance
184
tropical sprues is caused by ???? How is it treated?
bacteria
treat with abx
185
UC is a subtype of _____. Where does it most commonly affect?
IBD
sigmoid colon and rectum
186
What is the normal body temp?
98.6
187
a person commonly gains heat from _____ and _____
metabolic processes
environment
188
what are the four main ways you lose heat?
**radiation, convection, conduction, evaporation
189
_____ can boost how much heat you lose
Sympathetics
190
The majority of heat loss is through _____
radiation: 60%
191
convection heat loss, lose heat through _____
air currents
think like an over
192
conduction heat loss, lose heat through _____
touching an object or air
think like elctricity
193
evaporation heat loss, lose heat through _____
sweat
194
What is the main method of losing heat when it is too hot outside?
evaporation aka sweating
195
____ is responsible for overall temperature regulation
hypothalamus
196
When you sweat slowly (like after a jog), you (can/cannot) reabsorb the sodium you normally lose.
can reabsorb the sweat you lose
197
When you sweat profusely, you lose a lot of sodium. What is a common way to replenish?
pedialyte/gatorade help with people who are sweating A LOT
198
When you are too hot, the body adapts in what 3 ways?
Vasodilation
Sweat
Slowing metabolic processes
199
When you are too cold, the body adapts in what 3 ways?
Shivering
Piloerection (goosebumps/hair)
Increased metabolic processes
200
Overall, you are more sensitive to ____ than ____. 10x more receptors.
cold: 10x more receptors.
hot
201
What is a fever due to?
Increased set point within the hypothalamus due to endogenous pyrogens, like IL-1 and IL-6.
202
What two endogenous pyrogens are responsible for a fever?
IL-1 and IL-6.
203
Do platelets have a nucleus?
NO!
204
What is normal platelet count?
150K-450K
205
What is a low platelet count called?
Thrombocytopenia
206
What is a high platelet count called?
thrombocytosis
207
What is the 1/2 life of a platelet?
8-12 days
208
How are the majority of platelets removed?
by the spleen
209
What is the triggering factor for platelet plugs?
exposed collagen from damaged vascular wall
210
Collagen makes plts sticky and causes them to leak ____, ____ and _____
vWF, ADP, and thromboxane A2.
211
How long does it take to make a platelet plug?
15-20 seconds
212
platelet plug transitions into a clot when ???
you start activating fibrin
213
generally your body in in an _____
anticoagulant state
214
A ruptured vessel/damaged blood cells trigger ______
prothrombin activator
215
What is the rate-limiting step in clotting?
Availability of activator
216
Prothrombin activator activates ???? What does it need for this process?
prothrombin into thrombin
presence of sufficient Calcium ions
217
Where is prothrombin made?
in the liver
218
Thrombin converts ????
fibrinogen to fibrin
219
Where is fibrinogen made?
in the liver
220
Extrinsic pathway thinking ????? what is the lab measuring?
triggered by damage to walls
PT
221
Intrinsic pathway thinking ????? What lab measurement?
damage to the RBCs themselves
aPTT
222
What is the helpful analogy for extrinsic vs intrinsic?
223
Draw the diagram for extrinsic and intrinsic factors
224
Which factors does PT measure?
Measures 1, 2, 5, 7, 10 (AKA common pathway + extrinsic)
225
Which factors does aPTT measure?
Measures 1, 2, 5, 8, 9, 11, 12 (AKA common pathway + intrinsic)
226
How does heparin work?
it amplify Antithrombin 3 by 100x
227
What is the role of antithrombin 3
blocking and inactivation of thrombin. (Factor 2)
228
Plasmin came from _____.
plasminogen
229
____ can eat fibrin
plasmin
230
What is hemophilia related to? What can it cause?
eficiency of factor VIII (8) and causes large vessel bleeding
231
What does DIC stand for? Describe what happens.
DIC = disseminated intravascular coagulation
A trigger causes you to clot everywhere
You clot too much, you run out
Now you bleed everywhere.
232
a venous emboli will go to the _____
lungs
233
arteriole emboli tend to go the ___ and ____
brain and kidneys
234
Factor 1 is ____
fibrinogen
235
Factor 2 is _____
prothombin
236
Factor 3 is _____
tissue factor
237
Which clotting factor is vit K dependent?
factor 10
(Stuart-Prower factor)
