Patho tres

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  1. nephron
    functional unit of the kidney
  2. Vitamin D is actually a hormone

    what does the kidney do to Vit. D?
    ***Activate Vit. D to participate in Ca metabolism to increase absorption in the GI for bone deposition.

    ***Ca is converted to it's active form Calcitrol in the Kidneys
  3. 6 functions of the kidney
    • maintain fluid and acid/base balance
    • regulate electrolyte [ ]
    • detox blood
    • regulate bld pressure
    • erythropoiesis
    • Vitamin D and Calcium
  4. where is urine produce?
    in the pyramid lobe
  5. renal arteries:

    afferent vs. efferent
    A= supply glomerulus and are larger diameter

    E= exit glom and are smaller diameter to Vasa Recta
  6. podocytes
    give structure within the bowmans capsule
  7. renal calyx (calicies)
    where the renal pyramids drain
  8. Glomerulus
    • cluster of capillaries inside the Bowman's Capsule
    • **Responsible for filtering solutes from blood
  9. 3 components of urine production
    • **
    • filtration= occurs in glomerulus
    • re-absorption= substances like Na, K, Cl, peptides, glucose, etc.
    • secretion= if in excess
  10. Glomerular capillary system
    • **A unique high pressure cap filter system
    • selectively constricts and dilates to regulate glom pressure
  11. Mesanguim (of glomerulus)
    surround cap's for support and can contribute to regulation of glom bld flow
  12. fluid filters across the membrane between the Psuedopods, which do what?
    provide structure to capsule so fluid circulation is uninterrupted
  13. Vasa Recta
    • hairpin turn of blood vessels that surround the nephron
    • **venous-arterial system like a shunt that allows for correct secretion and re-absorption
  14. loop of henle

    6 sites of reab. and secr.
    R= H2O, electrolytes, amino acids, acid/base elements are returned to the blood

    S= (in the final adjustment) components leave the blood and are excreted in the urine

    • sites:
    • proximal tubule
    • descending tubule (thin)
    • ascending tubule (thin to thick)
    • early distal tubule
    • late distal tubule
    • collecting duct
  15. reabsorption and secretion on the proximal tubule
    R= Na, Cl, H2O, K, HCO3, glucose, amino acids

    S= H, organic acids and bases
  16. reabsorption of the descending loop of Henle
  17. reabsorp. and secret. of the Thick ascending tubule
    R= K, Cl, Na, Ca, HCO3, Mg

    S= H
  18. reabsorption of the early distal tubule
    Na, Cl, Mg, Ca
  19. late distal tubule and collecting duct are broken down into these 2 cell types:

    The distal secretes under the control of what?
    Principle and Intercalated

    under the control of aldosterone
  20. reabsorp. and secret. of Principle cells:

    reabsorp. and secret. of Intercalated cells:
    • Principle
    • R= Na, Cl, ADH-mediated H2O reabsor.
    • S= K

    • Intercalated
    • R= HCO3, K
    • S= H
  21. High vs. Low [ ] of ADH affect on solutes in urine
    high [ ]= less urine, more solutes

    low [ ]= more urine, less solutes
  22. avg. blood filtration rate
    120 mL/min
  23. Juxtag cells measure what?

    They also release what? In response to what?
    measure bld flow and urine flow and composition

    release Renin (**Primary function) in response to decreased pressure and increased Na
  24. Renin affects what?

    what does it do to vessels and BP?
    Renin affects angiotension and therefore angiotesion II which is a vaso constrictor, increaseing BP
  25. what is the relationship between K and Na?
    they are inversely related
  26. increase in aldosterone does what to K, Na, and bld flow to kidneys?
    • inc Na retention
    • inc K secretion
    • dec bld flow to kidneys
  27. what is the actual site of ADH action?
    • the collecting tubule
    • It makes the tubule more permeable
  28. What happens to Ca ions in the loop of Henle?
    they are reabsorbed
  29. How do NSAID's reduce renal blood flow?
    through inhibition of prostaglandin synthesis, which have a vasodilatory effect
  30. What does Atrial naturetic peptide (ANP) respond to?
    overstretched atria
  31. What does B-type naturetic peptide (BNP) respond to? 
    Overworked ventricles
  32. What do ANP and BNP do to the kindneys and blood volume?
    both cause kidneys to stop reabsorbing Na and H2O, which are lost in the urine, reducing bld volume and decreasing strecth and workload of the heart
  33. best test to measure health of the kindeys?
  34. Urine test
    specific gravity of:
    1. marked hydration
    2. healthy kidney
    3. loss of renal function
    • 1) 1.00
    • 2) 1.03-1.04
    • 3) 1.006-1.001

    these levels increase and decrease with the level of ADH released
  35. creatinine is a product of what?
    product of metabolism that is not reabsorbed in the tubules
  36. Body fluid I & O amount
  37. break down of the 60/40/20 fluid rule
    • 60% of the body is H2O
    • 40% of that is ICF
    • 20% is ECF
  38. Body fluid volume is regulated by what?
    ***the bodies Na content
  39. Insensible loss vs sensible loss
    Insense= loss that can't be measured (breath, sweat, etc.)

    Sense= can be measured (urine, sputum, feces, etc.)
  40. 3 types of ECF
    • interstitial
    • vascular
    • transcellular
  41. interstitial ECF
    between the cells and NOT circulating
  42. transcellular ECF
    spinal fluid, GI tract, urine, saliva, plueral fluid, ect.
  43. difference b/w adult and infant ICF amounts
    A= 2/3 of total body fluid

    I= have more and this changes after the first few months of age
  44. ECF and ICF fluid contents
    ECF= HIGH Na, Cl, HCO3, Ca

    ICF= HIGH K, Mg, phosphates and proteins
  45. Colloidal pressure
    **the osmotic pressure that is created by the plasma proteins that are too big to pass thru the capillary membrane
  46. Osmolarity is regulated by what molecule?
  47. How does high and low osmolarity control H2O balance through thirst?
    H= causes thirst and the release of ADH to retain H20

    L= lack or thirst and decreased ADH
  48. ADH imbalances:

    Diabetes Insipidus (DI)
    Syndrome of Inapproriate ADH (SIADH)
    D= No ADH released so excess H2O is voided

    S= body retains H2O
  49. what levels of K and Na do you expect to find in ICF and ECF?
    ICF= Increased K

    ECF= Increased Na
  50. 4 mechanisms of fluid movement
    • filtration
    • diffusion
    • active transport
    • osmosis
  51. filtration
    H2O moves from Higher hydrostatic PRESSURE to lower PRESSURE
  52. Diffusion

    2 types:
    • D= molecules move across semipermeable membrane from HIGH [ ] to LOW [ ]
    • **movement is through membranous pores OR a lipid matrix
    • "Diffusion Descends"

    • Simple
    • Facilitated
  53. simple diffusion
    passive movement of molecules through membrane
  54. facilitated diffusion
    molecule interact with carrier proteins to pass through.

    Need ATP
  55. Active Transport
    • movement of substance AGAINST their gradient
    • "Active Ascends"
    • Requires ATP
  56. Osmolarity vs Osmolality
    • rity= amounts of solutes per/L of solution.
    •   = Depends on the #, not the type of moleculre

    • lity= number of solutes per/kg of H2O
    •   = used to describe [ ] of body fluids

    • rity= solutes/Liter
    • lity= solutes/Kg
  57. mOs

    describes the [ ] of the solutes in the H2O
  58. fluid homeostasis is a dynamic process

    it involves 4 subprocesses:
    fluid homeostasis is a dynamic process

    • intake
    • absorption
    • distribution
    • excretion
  59. RAAS process
    • When BP drops:
    • 1. Juxtag cells release Renin
    • 2. angiotensinogen in blood
    • 3. angio I (not normally found in blood)
    • 4. angio II in the lungs (vasoconstrictor)
    • 5. Aldosterone in the Adrenal Cortex
    • 6. Retention of Na and H2O, raising BP
  60. what is Third Spacing Fluid Imbalance?
    fluid shifts from circ. to spaces where circ. in not in contact for reabsorption
  61. Fluid Volume: S & Sx

    deficit vs. excess
    Start by  checking lab results

    • *D=  HCT and BUN levels elevated
    •    = tachycardia and dec. BP b/c heart is working to hard

    • *E= H/H decreased
    •    = increase BP and vessel stretching
  62. 2 isotonic IV solutions
    NS and LR
  63. treatment of fluid deficit and excess
    1st, figure out what caused it
  64. Na
    Major electrolyte in the blood

    • reg.s Osmolality
    • reg.s Volume
    • maintains neuromuscular activity
  65. shrink or swell?

    hyponatremia vs. hypernatremia
    hypo= swell, overhydration

    hyper= shrink, dehydration
  66. 1st S & Sx of Hypernatremia?
    bounding pulse
  67. what type of solution should be given to treat hyponatremia?
  68. what regulates K?

    3 K functions 
    Kidneys are main regulator of K

    • fncts:
    • cellular metabolism
    • cardiac function
    • neuromuscular functions
  69. hypo vs hyperkalemia, which shifts K into the cell and which shifts out of the cell?
    hypo= into the cell

    hyper= out of the cell
  70. hypokalemia vs hyper causes
    hypo= vomiting, diarrhea, and drains are #1 cause of K loss

    hyper= renal failure, insulin deficiency
  71. treatment of hyper and hypokalemia
    hypo= NEVER GIVE K IVpush, ONLY VIA INFUSION because it is very potent.

    hyper= stop all supplements, give diuretics
  72. what type of Ca is active
    Only Ionized Ca is active

    Not active is bound to plasma proteins or citrate
  73. 3 things that Ca regulates?
    • muscle activity
    • cardiac function
    • blood clotting
  74. Major function of Ca
    ***to block Na gates in muscle and nerve cells to decrease firing
  75. What does the parathyroid hormone do to Ca?
    parathyroid hormone- release Ca from bone

    Calcitonin resleased from thyroid to stop PTH
  76. causes of hypocalcemia
    Vit. D deficiency (look @ decreased renal function)

  77. Mg
    Mg is the 2nd most abundant intracellular cation in the blood

    deficiency can lead to cardiac dysrhythmia

    significant to parathyroid and can cause lack of Ca --> dysrrythmia
  78. Why would you give a pt. 1 tablet of Mg once a day?
    not as a laxative, but to help regulate the heart
  79. Vitamin D
    actually a hormone produce by the kidney

    enables Ca absorption
  80. acid/base balance is a measure of what?
    • partial pressure of H+
    • pH
  81. 2 buffer systems of the body
    resp. and renal

    resp. is faster but less effective
  82. nl adult pH level
    death by pH levels
    nl= 7.35-7.45

    death=  < 6.9  and  > 7.8
  83. normal values of:

    PaCO2= 36-44mmHg

    HCO3= 22-26mEq/L

    PaO2= 75-100mmHg
  84. What test provides that best measurement of acid/base status?
    ABG test
  85. What compounds used in the resp. and renal buffer systems?
    resp= carbonic acid H2CO3 to CO2 and H2O

    Renal= bicarbonate ions HCO3, secreting H+
  86. accepting and donating H+

    acid vs base
    Acid donates

    Base accepts
  87. All body fluids contain some kind of buffer system
    All body fluids contain some kind of buffer system
  88. primary ECF buffer system


    primary ICF buffer
    ECF= HCO3

    ICF= Phosphate
  89. what do chemoreceptors in the lungs detect?
    PaCO2 and/or pH change and then adjust rate and depth of breathing
  90. infants excrete more HCO3 that children and adults
    infants excrete more HCO3 that children and adults
  91. In the renal system, what is added to buffer the H+ that help with excretion?
    Ammonia and Phosphate
  92. 3 types of cystic kidney disorders
    • simple (common)
    • acquired= dialysis can cause cysts from pressure changes
    • Medullary cystic disease - collecting ducts
  93. nephronopthisis
    • part of medullary cystic disease
    • scar tissue forms on the collecting duct
    • Prime candidate for a transplant
  94. Renal Calculi
    an obstruction such as a kidney stone
  95. 4 types pf kidney stones
    • Ca stones= 70-80% of all stones
    • Struvite= "Staghorn" associated with recurrent UTI's
    • Uric acid stones
    • Cystine stones
  96. Treatment of Renal Calculi
    • inc fluids
    • dec dietary Ca intake
    • drugs to bind Ca in gut
    • diet change to inc/dec pH of urine
    • diuretics
    • surgical invention/removal
    •  lithotripsy
    •  open removal
    •  ureteoscope
  97. UTI
    infection occurs OUTSIDE the body and Ascends up the urinary tract
  98. normal placement of the ureter
    angles so that there is a flap that closes upon micturation
  99. Pyelonephritis

    S & Sx
    Infection of the renal pelvis (bottom side) and kidney parenchyma of the kidney

    S & Sx= **high fever**, chills, headache, backpain
  100. Nephritic syndrome
    Neph with an "i" is an inflammatory response of the Glomerulus of kidney

    increases urine output
  101. Nephrotic syndrome
    the collection of symptoms that are caused by Glomerular Disease

    • inc permeability of glomerulus
    • edema
    • hyperlipidemia
    • **dec weight but inc H2O
    • **inc coagability b/c liver damage from lipid #'s
  102. can Nephrotic syndrome be reversed?
  103. can Sclerotic Glomerular disease be reversed?
    can not be reversed once Albumin is measurable in the urine
  104. 3 different types (causes) of Acute Renal Failure
    • Prerenal
    • Intrarenal
    • Postrenal
  105. Prerenal failure
    sudden and severe drop in blood supply to the kidneys (this can be anything that impedes bld flow)
  106. Intrarenal failure
    • trouble w/n the kindey itself
    • direct damage to the kidney by inflammation, toxins, drugs, etc.
  107. Postrenal Failure
    sudden obstruction of urine flow in the ureter, bladder, or urethra such as enlarged prostate, kidney stones, etc.
  108. Acute of Tubular Necrosis:

    what happens to the renal tissue and what classification of renal failure is it?
    • death of tissue of the nephron
    • Intrarenal classification
  109. Acute Tubular Necrosis:

    is due to what?

    is it reversible?

    3 phases:
    • due to ischemia or injury to glomeruls
    • *Sudden and severe decrease in renal function

    yes it is reversible

    • onset
    • maintenance
    • recovery
  110. Acute Tubular Necrosis phases:

    • O= injury to symptoms
    • M= oliguria-anuria, toxic metabolites
    • R= repair and return of function
  111. Chronic Renal failure
    • Chronic= is progressive
    •  = most often caused by diabetes
    •  = fewer nehprons are actually working
    •  = not reversible
  112. what is the 1st thing we see in the development of Chronic Renal Failure?
    Renal insufficiency, which is determined by the rise of Creatinin in the blood
  113. Azotemia

    • A= build up of nitrogenous waste in urine
    •  = metabolic acidosis develops b/c of waste build up

    U= clinical manifestations of renal failure
  114. what can radio contrast dyes cause?
    what do we need to do for the pt. immediately after the test?
    RC dyes can cause renal failure

    We need to overhydrate the pt after
  115. what type of solution is used in hemodialysis?
    diastilate, which is very hypertonic

    uses omosis and diffusion
  116. peritoneal dialysis
    used after hemodialysis is no longer possible

    Diastilate solution is inserted into cavity, let sit for few hours to pull waste and H2O into cavity, then emptied and measured
  117. what is the #1 problem with Peritoneal Dialysis?
    It is done at home, so the risk for infection if high
  118. what is the micturation relfex amount?
    150-250 mL of urine
  119. is it the para or sympathetic nervous system that controls the urge to pee?
    the parasymp.
  120. Neurogenic badder

    2 types of:
    a bladder that is no longer under our concious control

    • Spastic Bladder
    • Flaccid Bladder
  121. Spastic Bladder
    failure to store urine, any urine in bladder signals micturation

    • intermitten cath used to treat
    • Incontinence is a S & Sx
  122. Flaccid Bladder
    failure to empty bladder, no signals to micturate when the bladder is full

    continual filling

    • intermitten cath used to treat
    • Incontinence is a S & Sx
  123. 3 types of incontinence
    • stress
    • urge
    • overflow
  124. stress incontinence

    increased intra-abdominal pressure causes leakage (coughing, sneezing, etc.)

    can be reversed with Keagel Exercises
  125. Urge Incontinence
    feel the need to pee frequently b/c any urine in the bladder sends signal to go
  126. Overflow incontinence
    from overfilling of bladder until there is no more room, so some leaks out of the urethra
  127. where are the majority of nutrients and H2O absorbed in the GI tract?
    nutrients in the Jejunum and Sm. intestine

    H2O in the Lg. Intestine
  128. upper GI tract parts
    • mouth
    • esophagus
    • stomach
  129. middle GI tract parts
    Sm. intestines
  130. lower GI tract parts
    • cecum
    • colon
    • rectum
  131. GI accessory organs
    • salivary glands
    • liver
    • pancreas
  132. the accessory organs of the GI tract do what?
    keep things moist and moving
  133. what is made in the liver?
  134. endo vs **exocrine pancrease
    • endocrine= releases hormone
    • exocrine= release digestive juices, through a duct, which go to the duodum
  135. what does the pancreas do?
    breaks down fat and absorp glucose from the bld stream
  136. renal failure diet
    limit proteins
  137. where is the nausea center of the brain?
    the medula
  138. celiac disease
    gluten allergy
  139. 3 Physiologic protective responses of the GI tract
    • anorexia
    • nausea
    • vomiting
  140. 6 layers of the GI
    • peritoneum (& messentary)
    • longitudinal muscle
    • circular ms
    • submucosa
    • lumen of the gut
    • mucosa
  141. 3 Esophageal problems
    • dysphagia
    • achalasia (barrets and hiatal hernia)
    • GERD
  142. dysphagia


    • D=
    • A= either lower sphincter is hypo or hyper relaxed
    •   Hypo= can't swallow, wont open
    •   Hyper= too relaxes and stuff backs up leads to GERD --> if goes on long enough, Barrets esophagus results
    • G= gastroesophageal reflux
  143. what do lacteals do in the GI?
    absorb fatty acids
  144. H. pylroi
    • major cause of ulcers (especially peptic) *2nd most common cause of ulcers is NSAIDS
    • damages stomach lining
    • must be treated with antibiotics
  145. acute gastritis
    inflam of the stomach and happens most often with alcohol

    happens and goes away fast
  146. end stage renal complications such as
    • anemia
    • heart failure
    • dec. erythropoietin
    • azotemia
    • inc risk of fracture b/c Ca lack in bones b/c Vit D is not activated
  147. gi hormones:
    • 1. stimulates hunger - fundus of the stomach - sends out signal that it is not full***
    • 2. activated when food enters stomach -stimutlate digestive secretions - in the stomach antrum
    • 3. regulates pH in stomach - can signal pancreas to release bicarb - in duodenum
    • 4. helps action of Secretin - increase bile secretion from gallbladder in duo and jejunum
    • 5. stimulates insulin secretion- in Sm. intestine and jejun
  148. inflam of bowel wall can lead to 4 things:
    • hemorrhage --> anemia
    • perforation --> peritonitis
    • dec mucosal fnct --> malabsorption
    • dec bacterial conatinment --> sepsis
  149. bloog colors is gi:

    above the stomach
    into stomach w/ partial digestion
    into intestine without seeing it
    into intestine with blood mixing into stool
    into intestine with large amounts of blood
    into rectum
    • 1. frank hematemesis (red vomit)
    • 2. coffee-ground vomit
    • 3. Occult, need papar test to see
    • 4. melena (black) stool
    • 5. red coated stools
  150. malabsorption can be diarrhea OR constipation
    malabsorption can be diarrhea OR constipation
  151. Inflamm Bowel diseases
    • Uclerative colitis
    • Crohn's disease
    • Diverticular disease
  152. ulcerative colitis
    • inflam of colon mucosa
    • swollen to the point where it smooths out, so food can move thorugh but not be properly absorbed. So malnutrition is common.

    **nutrient and H2) malabsorption
  153. Crohn's disease
    • inflam bowel with many granules (papule looking)  **CHRONIC
    • R lower quadrant pain
    • bowel become thick, unable to produce mucosa, absorp nutrients, etc.

    will go through exasperation and remission

    **will see more undigested food than in ulcerative colitis
  154. Diverticular disease

    losis vs litis
    • pockets form in the GI tract
    • things can collect/stick in there

    • losis= have pouches only - eat high fiber food except seeds and nuts
    • litis= inflammed
  155. peritonitis
    perforation of the bowel wall
  156. Hepatitis:

    • Viral= 
    • A= fecal/oral route. not chronic
    • B= blood and/or body fluid contact
    • C= most common - causes chronic - from bld and body fluids. NO TREATMENTS
    • D= Hep B associated Delta Virus - from bld and body fluids leads to chronic
    • E= fecal/oral route. Not chronic. Fatal to mom and child if prego
  157. fecal/oral vs blood hepatitis
  158. risk factors of liver, pancreas, and gall bladder
    alcohol, Smoking, fatty diet, cysts and polyps, 
  159. when the pancreas is eating itself, what lab values will you see in the blood?
    • inc amylase and lipase
    • low serum Ca
  160. S & Sx of malfunction of the gall bladder
  161. S & Sx of malfunction of the pancreas
  162. S & Sx of malfunction of the liver
    • bleeding tendencies
    • dec metabolic function
    • decrease clotting factor synthesize
  163. liver failure
    cirrhosis= scarred liver tissue
  164. metabolic fncts of the liver
    • break down of proteins, fats, and carbs (meds and food)
    • **synthesizes clotting factors**
  165. fatty vitamins
    • A
    • D
    • E
    • K
  166. renal clearance
    ability to filtrate
  167. renal threshold
    amount of substance that is not normally seen in blood, but has become apparent
  168. renal filtration rate
    1.5 L per/day
  169. what happens to renal bld flow when there are changes if perfusion/SNS stimulation?
    • changes in these outcomes:
    • dec profusion or inc SNS stimulation. bld flow is distrib away from cortex to the medulla, dec glom filtr while maitianing the urine [ ] of the kidneys – important during shock
  170. ADH where and what does it do?
    • in collecting tubule.
    • inc reabsorp by making duct impermeable

    posterior pituitary releases ADH
  171. Lab values associated with renal function
    • creatinin 0.6-1.2
    • BUN 8-21
    • BUN/CREAT ratio 10:1
  172. Calcium
    blocks Na gates in nv and ms cells to dec firing. regulates bld clotting
  173. Sodium
    regulate osmolality, bld volume, maintains neruomsclar activity
  174. Potassium
    cellular matab, cardiac functs, neuromsclr fncts
Card Set:
Patho tres
2013-08-09 00:51:33
Patho exam

Patho exam 3
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