Renal Physiology Flashcards

(99 cards)

1
Q

Wegenerallyconsumeabout —- to —%moresaltandwaterperdaythanw e wouldneed(tomakeupforlossesthroughsweat,exhaledmoisture,andvia thefaces)ona naverageday.

A

20-25%

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2
Q

The kidneys, Both weigh —-i.e.— % of body weight.

A

300g
0.4%

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3
Q

Has a longitudinal slit called the —- which open into a shallowflattened C-shaped space-——-.

A

Hilus
Renal sinus

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4
Q

Hilus is occupied mainly by the

A

Renal pelvis

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5
Q

Minor calyxes join together to form

A

Major calyxes

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6
Q

Structures entering and leaving the kidneys include

A

Entering- renal artery and nerves
Leaving- renal vein , lymphatic vessels and ureter

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7
Q

A section of the Kidney shows 2 zones:
State their names and colors
The junction between the two zones is called—-

A
  • An outer reddish brown zone called the cortex
  • An inner paler striated zone called the medulla.

Corticomedullary junction

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8
Q

The cortex is made up of mainly

A

Highly convoluted proximal and distal tubules

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9
Q

The medulla has a striated look due to the presence of ——

A

Medullary pyramids

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10
Q

Medulla is divided into multiple cone shaped masses called

A

Renal pyramids

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11
Q

Base of each renal pyramid originates at the border between the —— and ——, and terminates in the ——

A

Cortex and medulla
Papilla

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12
Q

Each kidney is made up of how many nephrons

A

1-1.4 million

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13
Q

——— is the functional unit of the kidney

A

Nephron

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14
Q

List the types of nephrons, where they are located, where they originate from, and how many percentage of the total nephron they make up

A

Cortical
- superficially located
- originate from outer 2/3rd of the cortex
- more numerous
-forms 85% of total nephron

Juxtamedullary
- located deeper with longer LH
- originates from the inner 1/3rd of the cortex
- forms 15% of total nephron

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15
Q

——— and ——— forms the malphighian or renal corpuscles

A

Glomerulus and bowman’s capsule

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16
Q

———— is the internally dilated part of the nephron and it contains the glomerulus which is formed by the invergination ofa tuft of capillaries

A

Bowman’scorpuscle

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17
Q

The bowman’s corpuscle has a diameter of app —— um.The glomerular capillaries are supplied by ——-and drained by a ———

A

200um
Afferent arteriole
Smaller efferent arteriole

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18
Q

The glomerular capillary membrane has 3 major layers:
—————:-fenestratedwith pores of ~70-90nm indiameter.
————— found in-between the first two layers.
—————- -have numerous pseudopodia that interdigitate to form filtration slits or slits pores of~ 25nm wide.
In b/w the endothelium and the basal lamina are cells called the ——— cells - are contractile and help in regulation of glomerular filtration.

A

The glomerular capillary membrane has 3 major layers:
Capillary endothelium:-fenestratedwith pores of ~70-90nm indiameter.
A basement membrane basal laminar found in-between the first two layers.
Epithelial cells (Pondocytes)-have numerous pseudopodia that interdigitate to form filtration slits or slits pores of~ 25nm wide.
In b/w the endothelium and the basal lamina are cells called the mesangial cells - are contractile and help in regulation of glomerular filtration

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19
Q

The glomerular capillary membrane has 3 major layers:
Capillary endothelium:-fenestratedwith pores of ~— to —nm indiameter.
A basement membrane basal laminar found in-between the first two layers.
Epithelial cells (Pondocytes)-have numerous pseudopodia that interdigitate to form ——— or ——— of~ — nm wide.
In b/w the ——— and the ——— are cells called the mesangial cells - are contractile and help in regulation of glomerular filtration

A

The glomerular capillary membrane has 3 major layers:
Capillary endothelium:-fenestratedwith pores of ~70-90nm indiameter.
A basement membrane basal laminar found in-between the first two layers.
Epithelial cells (Pondocytes)-have numerous pseudopodia that interdigitate to form filtration slits or slits pores of~ 25nm wide.
In b/w the endothelium and the basal lamina are cells called the mesangial cells - are contractile and help in regulation of glomerular filtration

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20
Q

РСТ
• Made up of a —— layer of cells.
Made up of ——- cells
• Millions of ———(which increases the surface area for absorption).
• ——— mitochondria.
• —— surface of the cell bulge into the tubular lumen.Between the bases of the cells are —— spaces
• Convoluted part is called ———

A

РСТ
• Made up of a single layer of cells.
Simple cuboidal
• Millions of microvilli(which increases the surface area for absorption).
• High density mitochondria.
• Apical surface of the cell bulge into the tubular lumen.Between the bases of the cells are lateral spaces
• Convoluted part is called pars convoluta.

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21
Q

L.H
Descending thick limb(pars recta of the ——), descending thin limb and ascending thick limb(pars recta of ——)
• The cells are ——,—— and —- with ——— mitochondria.
The cells of the LH are made up of ——-
Glomerulus in the outer part of the cortex with short LH…—— nephron.Those with the glomerulus in the juxtaglomerular part of the cortex has long LH.. ———— nephron.

The thick ascending limb of the LH:cells are ——,mitochondria are ———.
• The tubules passes close to the afferent and efferent arterioles where the ——— epithelium are modified histological to form ———. In the afferent arterioles are the ——cell / —— cells,which together with the macular densa and the lacis cells are known as the ———.

A

L.H
Descending thick limb(pars recta of the P.C.T.), descending thin limb and ascending thick limb(pars recta of D.C.T)
• The cells are attenuated,flattened and thin with only few scattered mitochondria.
The cells of the LH are simple squamous
Glomerulus in the outer part of the cortex with short LH…cortical nephron.Those with the glomerulus in the juxtaglomerular part of the cortex has long LH.. Juxtaglomerular nephron.

The thick ascending limb of the LH:cells are cuboidal,mitochondria are numerous.
• The tubules passes close to the afferent and efferent arterioles where the tubular epithelium are modified histological to form Macula densa. In the afferent arterioles are the granular cell / juxtaglomerular cells,which together with the macular densa and the lacis cells are known as the juxtaglomerular apparatus.

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22
Q

DCT
• Shorter than PCT,few ——— with basal structure similar to PCT.
• Infolding of the cell membrane.——- mitochondria.
• ——-presence of mitochondria.
Epithelium is composed of—— type of cells

CD
• Average length of~ —- to — nm and diameter of~——u.
• Theepitheliumismadeupofcellsare are made up of the ——— cells , and ——-cells
• —— cells:involve in Na reabsorption and ADH water stimulate water reabsorption.
• —— cells are fewer and concerned with acid secretion and HCO3- Transport.
• In the interstitium of the medulla are secretory cells called of the “———”.

A

DOT
• ShorterthanPCT,fewmicrovilliwith basalstructuresimilartoPCT.
• Infoldingo fthecellmembrane.Few mitochondria.
• Densepresenceo fmitochondria.
Simple cuboidal
CD
• Averagelengtho f~ 20-22nmand diameterof~200u.
• Theepitheliumismadeupofcellsare aremadeu poftheprincipalcell( Pcells)
, andintercalatedcells(Icells).

• P cells:involvei nN areabsorptionand ADHwaterstimulatewaterreabsorption.
• I cellsarefewerandconcernedwithacid secretionandHCO3- Transport.
• I nt h einterstitiumo ft h emedullaa r e secretory cells called of the “type I medullary interstial cells”.

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23
Q

Blood supply.
• About — to —% of cardiac output
List the divisions starting from renal artery

A

22-25%
Renal artery, segmental, interlobar, arcuate, interlobular, afferent, efferent, peritubular capillary, venules, interlobular vein, arcuate vein, interlobar vein, renal vein

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24
Q

List 10 functions of the kidney

A

-Regulation of body water
- regulation of body electrolytes
- regulation of arterial BP
- production of prostaglandin
- regulation of RBC production
- activation of Vit D to active form
- regulation of blood pH
- gluconeogenesis
- excretion of waste products of metabolism
- excretion of foreign chemicals like pesticides
- secretion of hormones

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25
Urine formation is based on the formation of ———
Urine formation is based on the formation of glomerular filtrate
26
Urine formation involves
Glomerular filtration Tubular reabsorption Tubular secretion
27
Urine formation Involves 3 basic renal processes: - ———— :Filtering of blood into tubule forming the primitive urine - ———: absorption of substances. needed by body from tubule to blood - ————:Secretion of. substances to be eliminated from the body into the tubule from the blood
Urine formation Involves 3 basic renal processes: - glomerularfiltration(GF):Filtering of blood into tubule forming the primitive urine - tubular reabsorption(TR): absorption of substances. needed by body from tubule to blood - tubular secretion (TS) Secretion of. substances to be eliminated from the body into the tubule from the blood
28
In situation where there is: • 1.GF but no TS and TR, then Excretion= ———— • 2 . There is TS but no TR, then E = —— • 3 .There is GF there is TR but no TS, E= ———- • 4.——— (thereisF,Sand R).
In situation where there is: • 1.GF but no TS and TR, then Excretion= GF • 2 . There is TS but no TR, then E = G F + TS • 3 .There is GF there is TR but no TS, E= GF - TR • 4.E =(F+TS)-TR (thereisF,Sand R).
29
List the pressure involved in glomerular filtration and their values
- glomerular capillary blood pressure/ hydrostatic pressure(60mmHg) - plasma colloid osmotic/oncotic pressure(25) - bowman’s capsule hydrostatic pressure/tissue resistance (10)
30
Net filtration pressure is
25 mmHg
31
• Substances with molecules less than or equal to ——— are filtered. • The renal membrane is impermeable to plasma ———. All the cellular elements of the blood are filtered T or F • Glomerular filtrate is formed at the rate of——— m l / m i n o r —— L / d a y. • Entire plasma volume filtered — times/day
• Substances with molecules less than or equal to 68,000 are filtered. • The renal membrane is impermeable to plasma protein. All the cellular elements of the blood are not filtered(as they are too large • Glomerular filtrate is formed at the rate of 1 2 5 m l / m i n o r 1 8 0 L / d a y. • Entire plasma volume filtered 65times/day
32
List the factors affecting GFR
- glomerular capillary filtration coefficient - high protein intake - increased blood glucose - renal blood flow - tubuloglomerular feed back - the pressures involved in glomerular filtration - systemic arterial pressure - sympathetic stimulation
33
Composition of glomerular filtrate
Na,k,hco3,cl,mg,po4,SO42-,amino acids,glucose
34
Where is Na mostly reabsorbed and the percentage absorbed
PCT 90%
35
Where is water mostly reabsorbed and the percentage absorbed
PCT 90%
36
Where is k+ mostly reabsorbed and the percentage absorbed
PCT 90%
37
Where is glucose mostly reabsorbed and the percentage absorbed
PCT 100%
38
How many % of Mg is reabsorbed in th PCT
25%
39
How many % of Ca is reabsorbed in th PCT
65%
40
How many % of HCO3- is reabsorbed in th PCT
Totally reabsorbed
41
How many % of urea is reabsorbed in th PCT
Passively reabsorbed
42
How is PO4- is reabsorbed in the PCT, active or passive
Actively and depend on Tm
43
How many % of Mg is reabsorbed in th PCT
44
How is urea is reabsorbed in the PCT, active or passive
Passively
45
How is K+ is reabsorbed in the PCT, active or passive
Actively
46
How is glucose is reabsorbed in the PCT, active or passive
Actively
47
How is SO4, amino acids, traces of protein is reabsorbed in the PCT, active or passive
Actively
48
Fluid moving from the PCT is —tonic
Isotonic
49
CD • Wall impermeable to —— unless under —— influence. • Urea reabsorbed here.
CD • Wall impermeable to water unless under ADH influence. • Some Na+,Cl- actively reabsorbed • Hypertonicity of interstitial facilitate H20 movement from tubules into the interstitial s p a c e under the influence of ADH. • Urea reabsorbed here.
50
. Remnant urine moves into renal pelvis- using ——— for storage until it is voided • Adult urine contain • pH is between —- to —-
. Remnanturinemovesintorenalpelvis- u s i n gbladderf o rstorageu n t i li ti svoided • AdulturinecontainH20,Nat,K+,NHs,Ca, Mg, CI-, PO4, SO4-, urea, creatinine, urobilinogenandmetabolitesofhormones. • p Hisbetween5.0-7.0.
51
Counter current mechanism is also called
Hairpin counter current mechanism
52
————- explains the formation of concentrated urine in the kidney
Counter current mechanism
53
• The counter-current mechanism depends on a special anatomical arrangement of:——-. • The superficial layer has an osmotic pressure o f~——m o s m while in the deeper layers at the renal papillae,the osmotic pressure is ~——mosm.
• The counter-current mechanism depends on a special anatomical arrangement of: the loop of Henles, the vasa recta and the presence of ADH. • The superficial layer has an osmotic pressure o f~300m o s m while in the deeper layers at the renal papillae,the osmotic pressure is ~1200mosm.
54
v-shaped nephron is also called ——— in counter current mechanism
Counter current multiplier
55
ROLEO FV-SHAPEDNEPHRON:(counter currentmultiplier). • The fluid entering the LH is —— while the one leaving it is —— despite the fact that the ALH is impermeable to water. • As the fluid flows at the thick ascending ALH,there is active transport of —— from the lumen into the interstitial fluid and —— follow passively.
ROLEO FV-SHAPEDNEPHRON:(counter currentmultiplier). • The fluid entering the LH is isotonic while the one leaving it is hypotonic despite the fact that the ALH is impermeable to water. • As the fluid flows at the thick ascending ALH,there is active transport of Na from the lumen into the interstitial fluid and CI follow passively.
56
U shaped vasa recta is also called the ——— in counter current mechanism
Counter current exchanger
57
Vasa recta prevents indefinite build up of —— in the renal interstitial space
Salt
58
Define renal clearance
Plasma volume completely cleared of that substance per minute( ml/min)
59
The formula for clearance
Cx=UxVx / Px Cx=clearanceofsubstancex Ux=conc.o fx/mlo furine. V =vol.Ofurineproduced/min. Px=plasmaconc.ofsubs.X/mlofplasma.
60
Things used to determine the GFR from renal clearance
Inulin Creatinine
61
If a substance is filtered and reabsorbed but not secreted= clearance rate is —— than GFR • If a substance is filtered and secreted but not reabsorbed- clearance rate is —— than GFR
Less than Greater than
62
What is used to measure RBF during renal clearance
PAH( para amino hippuric acid)
63
Clearance technique is used in determination of —— and ——.
RBF GFR
64
Determination of GFR. • The substance used must be freely filtered, neither secreted nor reabsorbed... Thus, amount filtered =amountexcreted. The substance must possess the following properties:
Thesubs.mustpossesthefollowingproperties: • Easily filtered in the kidney. - not reabsorbed • Not secreted. - Not binding to plasma protein. • Not alter RBF or GFR. - not metabolized in the body . - Not toxic. • Easy to be measured in plasma and urine. - Not stored in the kidney.
65
Auto regulation The kidney regulates it’s own blood flow within a pressure range of —— to ——mmHg
80 to 180
66
——— is the ability of the tubules to increase reabsorption rate in response to tubular load/tubular inflow
Glomerulotubular balance
67
Glomerulotubular balance occurs in which part of the nephron and occurs mainly for which solute
PCT, LH Na
68
PH for arterial blood is
7.35-7.45 7.4 in the slide
69
Hydrogen ion regulation is by how many system and list them
Chemical Buffer system Respiratory Renal
70
List the three major chemical buffer systems we have
Bicarbonate Phosphate Protein Hemoglobin
71
Hydrogen ion secretion occurs in the PCT and in ——— cells
Hydrogen ion secretion occurs in the PCT and in type A intercalated cells
72
Water Sources: • ——— (——ml) • ——- (——ml • ———=(——ml To t a l =——ml Output: —— (——/day ——(——ml/day —— (——ml/day —— (——ml/day TOTAL=———ml/day
Sources: • Ingestedliquid(1600ml) • Food700ml • Metabolism=200ml To t a l =2,500ml Output: Kidney 1,500/day Skin500ml/day Lungs300ml/day GIT200ml/day TOTAL=2,500ml/day
73
The principal function of ADH is Another name for ADH
Retention of water by the kidneys Vasopressin
74
Anti-DiureticHormone: Regulating the body fluid balance by increases t h e permeability of the ——-and the ——— parts of the nephron. Deficiency of this hormone lead to ——-. .
Anti-DiureticHormone: Regulating the body fluid balance by increases t h e permeability of the distal tubules and the collecting ducts. Deficiency of this hormone lead to diabetes insipidus i . e .formation of hypotonic large volume of urine with net water loss from the body. • In large doses(i.e.above the amount released under physiological conditions) it exerts an hypertensive pressure effect i.e.causes peripheral vasoconstriction of arterioles and capillaries
75
RAAS Stimulates Sodium Reabsorption in —— and ——— ports of the nephron • ——— peptide inhibits it • Aldosterone can cause ——% retention One of the body's most powerful controller of Na excretion is —-.
RAAS Stimulates Sodium Reabsorption in distal and collecting tubules • Naturetic peptide inhibits • Aldosterone can cause 99.5% retention One of the body's most powerful controller of Na excretion is Agll
76
ANP increases the rate of
Glomerular filtration
77
Erythropoietin is produced by ——/ cells
Peritubular cells
78
T h eKidneyproduces3 hormones:
T h eKidneyproduces3 hormones: _Renin •Eryrhropoetin = 1,25-dihydroycholecalciferol
79
Am acid protease secreted by the juxtaglomerular cells known as ——
Renin
80
List the three stimuli aldosterone responds to
Fall in sodium, ECF Volume,Blood Pressure
81
List 5 functions of angiotensin 2
1 .Stimulate adrenal cortex to secrete aldosterone. 2 .Produces arteriolar constriction thus increasing B.P. 3 .Increases water intake,increasing vasopressin release. 4 .Increase ACTH secretion 5 .Decreases sensitivity of the baroreceptor thus potentiating its pressor effect
82
ERYTHROPOIETIN. • It is a circulating glycoprotein that brings adjustment in erythropoiesis. • —% produced in the kidney and —% in liver. 1⁄2 life of — hours in circulation. Act to increase the number of —— cells in the bone marrow. Main stimulus is ——. ——— at high altitudes and ——— also act as stimuli. Others are ———,——-. Inhibited by adenosine antagonists- ——.
ERYTHROPOIETIN. • It is a circulating glycoprotein that brings adjustment in erythropoiesis. • 85% produced in the kidney and 15% in liver. 1⁄2 life of 5 hours in circulation. Act to increase the number of erythropoietin-sensitive stem cells in the bone marrow. Main stimulus is hypoxia. Alkalosis at high altitudes and hemorrhage also act as stimuli. Others are catecholamines,adenosine. Inhibited by adenosine antagonists- theophylline.
83
1,25-dihydrovcholecalciferol • It is a steroid hormone and the active form of vit.—. In the liver vitamin D3 is converted into ———— which is then converted in the proximal tubule of the kidney into the active form ————— conversion catalyzed by ———
1,25-dihydrovcholecalciferol • It is a steroid hormone and the active form of vit.D3. In the liver vitamin D3 is converted into 25, hydroycholecalciferol which is then converted in the proximal tubule of the kidney into the active form 1,25dihydroycholecalciferol conversion catalyzed by 1a-hydroylase
84
———— the process by which the urinary bladder is emptied i.e.urination. It is a complex act involving both ——— &——— nerve pathways& several reflexes that can be either inhibited or facilitated by higher centers in the brain.
It is the process by which the urinary bladder is emptied i.e.urination. It is a complex act involving both autonomic &somatic nerve pathways& several reflexes that can be either inhibited or facilitated by higher centers in the brain.
85
Micturition involves two processes:
The progressive filing of the bladder until the tension rises above the thresholdlevel. 2.nervous reflex called micturition reflex
86
The bladder muscles is innervated by both the —— and ——-.
Thebladdermusclesisinnervatedbyboth t h esympatheticandparasympathetic.
87
Micturition Sympathetic nerve does what . • • Parasympathetic nerve does what Pudendal nerves does what The bladder muscle is called the —— muscle.
Sympathetic nerve inhibits the bladder and stimulate the internal sphincter. • • Parasympathetic nerve stimulate the bladder and inhibits the internal sphincter. Pudendal nerves stimulate the eternal sphincter. The bladder muscle is called the detrusor muscle.
88
Micturition Sympathetic • ——— nerves(list the vertebrae) • has —— &—— fibers Bladder wall —— • Internal sphincter ——- Parasympathetic • —— nerves(list the vertebrae) - has ——-&——- fibres • Bladder wall ——- • Internal sphincter ———
Micturition Sympathetic • Hypogastric nerves( L1,L2,L3) • motor&sensory fibers Bladder wall relaxation • Internal sphincter contraction Parasympathetic • Pelvic nerves(S2,S3,S4) motor&sensoryfibres • Bladder wall contraction • Internal sphincter relaxation
89
• First sensation of bladder filling is experienced at a volume of —— to ——ml in an adult. • Then the 1st desire to void/ urinate is when the bladder contains about —— to —— ml of urine. • A person becomes uncomfortably aware of a full bladder when the volume is —— to —— ml . • The volume of urine that normally initiates a reflex contraction is about —— to ——ml. " an increase in volume to —— ml creates pain and loss of control!
• First sensation of bladder filling is experienced at a volume of 100- 150ml in an adult. • Then the 1st desire to void/ urinate is when the bladder contains about 150-250ml of urine. • A person becomes uncomfortably aware of a full bladder when the volume is 350-400m l . • The volume of urine that normally initiates a reflex contraction is about 300-400ml. " an increase in volume to 700 ml creates pain and loss of control
90
Cystometrogram • Empty bladder • ——cm of water intravesicular pressure • 30-50ml urine in bladder pressure: —- to —-cm of water -200-300ml urine in bladder • what happens pressure rise - more than 300ml urine • what happens to pressure
Cystometrogram • Empty bladder • 0 - intravesicular pressure • 30-50ml urine in bladder pressure: 5-10cm of water -200-300ml urine in bladder •pressure rise minimum - more than 300ml urine • rapid increase in pressure
91
Cystometrogram • —— bladder • 0 - intravesicular pressure • — to —ml urine in bladder pressure:5 to10cm of water -——to —ml urine in bladder •pressure rise minimum - more than —ml urine • rapid increase in pressure
Cystometrogram • Empty bladder • 0 - intravesicular pressure • 30-50ml urine in bladder pressure: 5-10cm of water -200-300ml urine in bladder •pressure rise minimum - more than 300ml urine • rapid increase in pressure
92
Cystometrogram is a plot of——— vs —— in the bladder
Cystometrogram is a plot of intravesical pressure vs volume of fluid in the bladder
93
• Law of Laplace states that
• Law of Laplace • Pressure in a spherical viscus is equal to twice the wall tension divided by the radius P = 2 T/ r
94
Micturition reflex are self regenerative T or F
T
95
Higher centers for micturition Facilitatory areas: Inhibitory areas:
Facilitatory areas: Pons Posterior hypothalamus Inhibitory areas: Cerebral cortex Mid brain
96
Explain atonic bladder
1.Atonicbladder Bladder loss the tone • Cause:sensory nerve fibers (afferent) from bladder to spinal cord are damaged • crush injury to the sacral region of the spinal cord,tumours,tabes dorsalis • intact efferent fibers • all reflex contractions of bladder lost • Bladder becomes distended,thin-walled and hypotonic • The bladder fills to capacity and over flows a few drops at a time through the urethra • overflow incontinence
97
Explain Denervation/Hyperactivebladder
Denervation/Hyperactivebladder • Cause: - tumors of cauda equina/ filum terminale B l a d d e r flacid& distended •Gradually, muscle o f the decentralised bladder' becomes active and shows many contraction waves -Dribbling of urine out of urethra - Bladder becomes shrunken & bladderwall hypertrophied • denervation hypersensitivity • increase tone - hyperthophy
98
Explain automatic bladder
3 .Automaticbladder • Cause:spinal cord damage above sacral region • Highercentercontrolisloss(voluntary control loss) • Sacral micturition reflex centers are intact • Suppression of micturition reflex during spinal shock due to loss of facilitatory impulses from brain • reflex returns after spinal shock Bladder becomes overfilled, can't urinate voluntarily - urine dribbles through sphincters • overflow incontinence
99
Explain Uninhibited Neurogenic Bladder
UninhibitedNeurogenicBladder •Cause:damage to brain/spinal cord that control inhibitory signals for micturition •Frequent and uncontrolled micturition • continuous facilitatory signals to bladder •even a small quantity of urine in bladder initiate powerful micturition reflex and empties the bladder