Pathophys Test 3

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Author:
cgordon05
ID:
14491
Filename:
Pathophys Test 3
Updated:
2010-04-14 14:13:56
Tags:
Renal 16 21
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Description:
Renal 16-21
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  1. What is the kidney's role in regulating BP? (p.20)
    What mechanisms are involved?
    • Renin-angiotensin system
    • Sodium homeostasis
    • Renal vasodepressor substances (dilators)
  2. Humoral factors - constrictors
    (BP regulation)
    • Increase BP
    • Include:
    • - Angiotensin II - most powerful vasoconstrictor
    • - Catecholamines
    • - Thromboxanes
    • - Leukotrienes
    • - Endothelin
  3. Humoral factors - Dilators
    (BP Regulation)
    • Decrease vascular resistance = decrease BP
    • Include: relaxing factors
    • - Prostaglandins (PG)
    • - Kinins
    • - Nitric oxide/EDRF
  4. Volume factors
    (BP Regulation)
    • Sodium = eat a lot of salt --> drink a lot of water --> retain volume
    • Mineralcorticoids = steroids encourage Na+ retention --> retain volume
    • Atrial natriuretic peptide (ANP) = encourages volume retention
  5. What are determinants of arterial blood pressure? (p.19)
    • BP = cardiac output (CO) x peripheral resistance (PR)
    • Influenced by:
    • - blood volume
    • - humoral factors
    • - cardiac factors
    • - neural factors
    • - local factors
  6. What effect do humoral factors have on renal vasculature? (e.g., PGE2) (p.20)
    • PGE2 (prostaglandin E2) - relaxing factors
    • - cause vasodilation, primarily of afferent arterioles
    • - improves glomerular blood flow
    • - decreases ischemia
    • - counterbalance effects of vasoactive agents like renin, endothelin, and angiotensin
  7. Essential hypertension (p.19)
    • 90% of people with elevated BP
    • Idiopathic
    • Precise cause not known or clearly understood
  8. Secondary hypertension
    • 10% of people with elevated BP
    • Most usually due to renal disease
    • Sometimes narrowing of renal artery from atheromatous plaque
    • Rarely caused by adrenal disorders:
    • o Aldosteronism (excess aldosterone)
    • o Cushing’s
    • o Pheochromocytoma
  9. What physiologic factors contribute to essential hypertension?
    Combination of lifestyle factors and genetic defects that interact to increase BP
  10. Established risk factors for hypertension: (p.21-22)
    • Genetic factors
    • Racial factors – more prevalent in black
    • Age/sex
    • - 35-45 years
    • - Sex – more common in females (better prognosis for females; males 1.5-2 times mortality)
    • Environmental: Stress – living in urban areas
    • Diet – obesity and salt
  11. Treatment and management of hypertension
    • Rule out secondary causes
    • Do serum Na+/K+, Mg2+, Ca2+ (maybe RBC Mg2+)
    • Decrease weight if obese
    • Decrease ratio of NaCl to K+
    • - Increase food low in NaCl
    • - Increase food high in K+ (like tubers, roots, cereal grains, seeds, nuts, and fruits – apples) – also high in Mg2+
    • Program of regular exercise
    • - Maintain ideal weight
    • - Improve insulin resistance
    • Avoid alcohol if heavy drinker
    • Smoking cessation
    • Oral contraceptives –
    • - Possible estrogen and progestin facilitation of Na+ and H2O retention secondary to increased plasma renin activity
    • Drug therapy if necessary
  12. What effect will cytosolic Ca2+ and Mg2+ have on arterial smooth muscle cells? (p.23)
    Calcium stimulates contraction of smooth muscle cells
    Magnesium causes dilation
    • Calcium stimulates contraction of smooth muscle cells
    • Magnesium causes dilation

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