McCormick lectures Flashcards by Alex Hamidi

hypoxia results in what compared to normal?

INcreased ICF Na

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ICF osmolarity is due to what?

K+

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The cell membrane between ECF and ICF is permeable to what?

water

NO IONS

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the capillary membrane between ECF compartments is permeable to what?

small ions

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how is fluid distribution between plasma and interstitial fluid maintained?

balance of hydrostatic and osmotic forces across capillaries

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how is fluid distribution between ECF and ICF determined?

osmotic effect of small solutes across cell membrane (highly permeable to water)

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what fluids stay in the ECF only?

whole body?

crystalloid fluids

saline

lactated Ringer’s Solution

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what kind of fluids contain large proteins and molecules which stay within the vascular space?

colloid fluids

dextran, albumin, mannitol

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what is non-pitting edema?

swollen cells due to increased ICF volume

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what is pitting edema

increased interstitial fluid volume

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what are the 3 anatomical urinary tract divisions?

upper
bladder
urethra

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what composes the upper urinary tract?

CPU
calyces
pelvis
ureters

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what controls voiding of the urethra?

2 sphincters

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internal sphincter:

smooth or skeletal m.?

Symp or PS?

voluntary/involuntary?

smooth

involuntray

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what is the afferent pathway for bladder fullness?

pelvic splanchnic nerve or hypogastric plexus

POSTERIOR column

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afferent pathway for bladder pain?

pelvic splanchnic n. / hypogastric plexus in the

ANTEROLATERAL column

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reflex arc from the bladder?

bladder –> sacral detrusor nucleus –> bladder

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reflex arc from urethra?

urethra –> sacral pudendal nucleus/sacral micturition center –> voluntary sphincter

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where do the reflex arcs occur?

S2-S4

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what nt does Symp fiber use?

where does it originate?

what does it pass through?

function?

NE
intermediolateral spinal gray horn T10-L2
hypogastric plexus
inhibits voiding

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what nt does PS use?

origin?

what does it pass through?

function?

Ach

sacral detrusor/micturition center S2-S4

pelvic splanchnic nerve

contracts detrusor, relaxes sphincter

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somatic fiber origin?

passes through what?

function?

sacral pudendal nucleus, S2-S4

hypogastric plexus and pelvic splanchnic nerve

contracts external urethral sphincter (rhabdomyosphincters)

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what overrides the urge to void?

how?

Pontine micturition center (barrington’s center) located at the pons

control of sacral micturition center and thoracolumbar sympathetic outflow

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what does Barrington’s Center coordinate?

activity of bladder and urinary sphincters

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Tension = ?

(P x r) / 2

where do bladder stretch receptors send sensory info to?

sacral micturition center --> activate PS higher centers in brainstem, cerebral cortex --> inhibit PS

what is the cause of an atonic/flaccid bladder? what happens to the bladder?

destruction of afferent inputs via injury, Diabetes, syphilis, MS stretch info not transmitted, no contractions, bladder fills to capacity and overflows, walls get thin and distended AA

what causes denervated (hypertrophic areflexic) bladder? what is the result?

destruction of afferent and efferent detrusor contractions cease, bladder becomes flaccid and distended later the detrusor has spontaneous activity and bladder shrinks due to hypertrophy of wall DD

what causes automatic (spastic) bladder? result?

injury/severed spinal cord above sacral region cuts off brain communication spinal shock suppresses micturition reflex makes flaccid bladder control by brain is lost, spastic bladder A.I.

what causes uninhibited neurogenic bladder (dysreflexia)?

destruction of somatic tracts for inhibition micturition is activated by small amounts of urine (constantly stimulated) detrusor hypertrophies, bladder capacity reduced UTI

what causes UTI? result?

E. coli uninhibited contraction of detrusor m. w/micturition reflex urinary freq and leakage

what is isosmotic volume contraction? expansion?

vomiting, diarrhea, hemorrhage infusion of 0.9 NaCl

what is hyperosmotic volume contraction?

loss of water dehydration diabetes insipidus

what is hyperosmotic volume expansion?

gain NaCl excess NaCl intake mannitol infusion

what is hyposmotic volume expansion?

gain water SIADH psychogenic polydipsia

hyposmotic volume contraction?

lose NaCl hypoaldosteronism adrenal insufficiency diuretics

what is ECF osmolarity due to? bc of what?

Na and Cl Na-K ATPase pump

Do the glomerular capillaries have a high or low hydrostatic pressure? net result?

HIGH filtration into Bowman's capsule

what kind of pressure do the peritubular capillaries have? net result?

low hydrostatic pressure water and solute reabsorbed

where do sympathetic neurons synapse to cause renin secretion?

granular cells

what are the effects of sympathetic discharge on the kidney?

DEC GFR inc reabsorption of Na and water from PCT and DCT thirst via AgII production

Filtration rate equation

filtration rate = GFR x plasma [ ] of substance

urinary excretion rate equation

= urine flow rate x [ ] of substance

clearance of substance X = ?

(Ux x V) / Px [ ] of X in urine x urine volume / [ ] of X in plasma

what does inulin clearance equal?

GFR

what are some advantages of using Cystatin C for measuring GFR?

levels not affected by muscle mass, age, or gender

when do PAH estimations for RPF become less useful?

at higher plasma [ ]'s of PAH

what is filtration fraction equation?

FF = GFR/RPF

increased FF means what?

increased oncotic pressure of efferent arteriole, more reabsorption

RBF equation?

RBF = RPF / (1-Hematocrit)

what is main function of ADH?

makes the collecting ducts permeable to water

when is ADH released?

increased blood osmolarity decreased blood volume

what is the main function of aldosterone?

reabsorb Na+ from DCT secrete K+ into urine

what effects does aldosterone have on volume and osmolarity?

Increases volume no change in osmolarity

what effects does ADH have on osmolarity and volume?

Decreases osmolarity Increases volume

where are osmoreceptors located?

anterior hypothalamus

where are volume receptors located?

Right Atrium

what are the physiological causes of proteinuria?

orthostasis (esp. in children) strenuous physical activity like running a marathon

what are the 4 pathological causes of proteinuria?

loss of charge barrier loss of size barrier failure of PCT to reabsorb protein overload proteinura, inc. plasma [ ]'s of low mw, filterable proteins

what is RBF equation?

RBF = change in pressure / Resistance

what can change the Kf?

surface area | permeability (Lp)

what do mesangial cells do to GFR?

decrease it bc they decreases the s.a.

Puf equation?

Puf = Pgc - Pbc - pigc

what does a kidney stone or blockage do to GFR?

DECREASE it

how is GFR primarily regulated?

Pgc

what BPs is GFR regulated over?

80-170

what does sympathetic stimulation do?

constrict afferent and a little efferent Dec GFR, DEC RBF activate RAAS to raise BP and INC Na and water reabsorption

what is PG release enhanced by?

ADH and NO

what hormones decrease GFR?

NE Epi Endothelin

what hormones increase GFR?

NO | PG

what is the myogenic response of autoregulation in response to?

INC. systemic arterial pressure

what happens in myogenic response?

resistance of blood vessels stretch vascular smooth m. contraction in response via INC Ca2+ movement into cells Result is prevents INC RBF and GFR when BP INC.

what is the TGF response to INC renal perfusion pressure?

constriction of afferent arteriole (Decreases GFR) via Adenosine

what is the TGF response to decreased renal perfusion?

INC sympathetic discharge activate RAAS to Inc efferent arteriole constriction will reabsorb Na and water

what is the criteria for diagnosing a UTI?

if urine collected by clean catch need both pyuria and at least 50,000 colonies if by catheter: pyuria and 50,000 or 10-50,000 cpm confirmed by repeat

if urine collected via suprapubic aspiration, what meets the criteria for diagnosis of uti?

pyuria and ANY growth on culture

what enzyme will present with a positive uti?

leukocyte esterase

gram negative bacteria? gram positive?

PECK SEnterococcusS

what is renal scarring?

loss of renal parenchyma between the calyces and renal capsule

what antibiotic do you use to treat uti?

cephalosporin or fluoroquinolones

when do you image with VCUG?

after 2nd uti OR after 1st uti with abnormal RBUS and temp > 39 C

what are the 2 major tests for detecting proteins and what are their major characteristics?

Dipstick test - color rxn to protein more sensitive to albumin Sulfosalicylic acid test - detects all proteins, the more turbid, the higher the protein [ ]