LEC 3 Exam.txt

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LEC 3 Exam.txt
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  1. The process of altering the chemical and physical composition of food so that it can be absorbed and used by the body cells is known as:
    Digestion.
  2. The innermost layer of the GI wall is called the:
    Mucosa
  3. What actions on nutrients does the digestive system perform?
      • Ingest
      • Digest
      • Absorb
      • Eliminate
      Food is broken down physically and chemically (enzymatic hydrolysis) into smaller diffusible molecules (nutrients).
  4. What compounds does the digestive system act on?
      • Carbohydrates
      • Fats
      • Amino Acids
      • Water
      • Minerals
      • Vitamins
  5. The _____ consists of portions of two maxillary bones and two palatine bones.
    Hard palate
  6. Describe the musculature of the GI track
      • It is the 3rd layer from the lumen and is called the Muscularis.
      • It is composed of an inner layer of circular muscle, and an outer layer of longitudinal muscle.
  7. What type of epithelial cells line the mucosal layer of the GI tract?
    Stratified squamous for abrasion resistance in the esophagus, and simple columnar for absorption and secretion in the remainder.
  8. The dorsal surface of the tongue is covered with rough elevated projections called:
    Papillae
  9. Name the four papillae of the tongue and those that do not have taste buds.
      • Circumvallate
      • Foliate
      • Filliform
      • Fungiform
      Only Filliform do not have taste buds.
  10. What is the medical name for tongue-tied and its cause.
    Ankyloglossia is cause by too short lingual frenulum.
  11. Types of tongue muscles, their general anatomy, and use.
    Intrinsic muscles have their origin and insertion in the tongue itself. Extrinsic muscles insert into the tongue, but have their origin in some other structure, for example the hyoid. Intrinsic muscles provide a high degree of maneuverability. Extrinsic muscles are important during deglutination (swallowing) and speech.
  12. Name the pairs of salivary glands:
      • Parotids (enzymes only)
      • Submandibulars (enzymes & mucus)
      • Sublinguals (mucus only)
      ~1 liter per day.
  13. Early in life, 20 deciduous teeth appear. Later these are replaced by _____ permanent teeth.
    32
  14. The _____ is a collapsible tube that extends from the pharynx to the stomach.
    Esophagus
  15. Describe the muscles of the esophagus.
    First third: Striated, second third: mixed, last third: smooth only.
  16. The sphincter muscle that controls the opening of the esophagus into the stomach is the _____ sphincter.
    Cardiac
  17. What is a hiatal hernia?
    An enlargement of the esophageal hiatus that can allow parts of the lower esophageal sphincter and some of or all of the stomach up into the thoracic cavity.
  18. Name the three parts of the stomach.
    Fundus – above the cardiac sphincter, body – main bulk part, and pylorus – in the vicinity of the pyloric sphincter to the duodenum.
  19. The epithelial lining of the stomach is thrown into folds, which are called:
    Rugae
  20. Gastric glands contain how many major secretory cells, and they are called…
    Chief, parietal and endocrine
  21. What is intrinsic factor?
    A secretion of the parietal cells of the stomach (along with HCl), that binds to vitamin B12, protecting it from the digestive environment of the stomach until it can be absorbed via the small intestine.
  22. What does the stomach absorb itself?
    Certain drugs, some water, alcohol and some short-chain fatty acids found in butter or milk fat.
  23. The three “divisions” of the small intestine are:
    Duodenum (10 inches), followed by the jejunum (8 feet), then the ileum (12 feet).
  24. The intestinal lining has circular folds that contain many tiny projections called:
    Villi

    Villi are modifications (projections) of the mucosal layer of the small intestine. Intestinal digestive enzymes are produced in the brush border cells toward the top of the villi. The presence of villi and microvilli increases the surface area of the small intestine.
  25. The large intestine is divided into the:
    Cecum, colon, and rectum
  26. The structure that permits material to pass from the ileum into the large intestine is the:
    Ileocecal valve.
  27. A fan-shaped projection of the parietal peritoneum is called the:
    Mesentery
  28. Four main divisions of the colon?
    Ascending colon, transverse colon, descending colon, and sigmoid colon.
  29. What are haustra?
    Pouch-like rings in the large intestine formed by the taeniae coli and circular muscles.
  30. Vermiform appendix location?
    It is most often found just behind the cecum or over the pelvic rim. It is attached to the cecum of the large intestine near the ileocecal valve.
  31. The largest gland in the body is the:
    Liver
  32. The hepatic duct merges with the cystic duct from the gallbladder, forming the _____ duct.
    Common bile
  33. Functions of the Liver
      • Liver cells detoxify various substances.
      • Liver cells secrete about a pint of bile a day.
      • Liver cells carry on numerous important steps in the metabolism
      • of all three kinds of foods—proteins, fats, and carbohydrates.
      • Liver cells store several substances —iron, for example, and
      • vitamins A, B12, and D.
      • The liver produces important plasma proteins and serves as
      • a site of hematopoiesis (blood cell production) during fetal
      • development.
  34. The main components of bile are:
      • Bile salts
      • Bile pigments
      • Cholesterol
  35. The function of the gallbladder is to:
    Store bile
  36. Jaundice: cause and effect
    Caused by an obstruction of bile flow to the duodenum. Since it is denied this exit route from the body through feces, an excess of bile pigments (with yellow hues) enters the blood and is deposited in tissues.
  37. The organ that is composed of both endocrine and exocrine tissue is the:
    Pancreas
  38. Chemical digestion requires the secretion of _____ into the lumen of the GI tract.
    Digestive enzymes
  39. The process of deglutition includes all of the following except the _____ stage.
    Laryngeal
  40. The wave-like ripple of the muscle layer of the GI tract is called:
    Peristalsis
  41. Fats and other nutrients in the duodenum stimulate the intestinal mucosa to release a hormone called:
    Gastric inhibitory peptide
  42. What triggers the enterogastric reflex to inhibit gastric emptying?
      • Hormonal via fats and other nutrients entering the duodenum, which causes the intestinal mucosa to secrete the hormone gastric inhibitory peptide (GIP) which decrease peristalsis in the stomach.
      • Nervous via receptors in the duodenal mucosa which sense both acid and stretch and via the vagus nerve also decrease peristalsis in the stomach.
  43. The chemical process in which a compound unites with water and then splits into simpler compounds is called:
    Hydrolysis
  44. Because fats are insoluble in water, they must be:
    Emulsified.
  45. Saliva contains the enzyme:
    Amylase
  46. What type of reaction do all digestive enzymes catalyze?
    Digestive enzymes catalyze the hydrolysis of food molecules. Note: where they work, extracellular, is not a “type” of reaction.
  47. Factors that change the shape of an enzyme, thus altering its function?
    pH and temperature.
  48. Final digestive products of Protein, Carbohydrate, and Triglyceride?
      • Protein – amino acid
      • Carbohydrate – glucose
      • Triglyceride - fatty acids and glycerol.
  49. Primary components of saliva.
    Water, mucus, amylase, lipase, and sodium bicarbonate.
  50. (F17) Components of Gastric Juice and the cells that create them?
    • Gastric juice contains:
      • Water, mucus, pepsin (chief cells)
      • Acidic Mucus (mucosal neck cells)
      • Pepsinogen, i.e. enzymes of gastric juice (chief cells)
      • Hydrochloric acid & Intrinsic Factor (parietal cells)
      • Gastrin, and ghrelin (GHRL) – a hormone that stimulates the hypothalamus to secrete growth hormone and increase appetite (endocrine cells)
  51. Pancreatic Enzymes
    Trypsin, trypsinogen, enterokinase, chymotrypsin, nuclease, and amylase.
  52. What are components of bile excretions?
    cholesterol, products of detoxification, and bile pigments
  53. Stimulation of gastric juice secretion occurs in all of the following phases except the _____ phase.
    Digestive
  54. Stimulation of gastric juice secretion occurs all of the following phases:
    Cephalic, Gastric and Intestinal
  55. The ejection of bile from the gallbladder is controlled by which hormones?
    CCK and secretin
  56. What does gastric inhibitory peptide (GIP) do?
    Inhibits gastric secretion and motility. Enhances insulin secretion.
  57. The final step in lipid transport by the intestines is the formation of:
    Chylomicrons - another form of micelles that are formed by the Golgi apparatus after absorption.
  58. The act of expelling feces is called:
    Defecation
  59. _____ is a general term referring to the inflammation of the liver.
    Hepatitis
  60. Define Cirrhosis
    Degeneration of the liver whereby damaged liver tissue is replaced by fibrous or fatty connective tissue.
  61. The principal organ of the urinary system is the:
    Kidney
  62. The branch of the abdominal aorta that brings blood into each kidney is the:
    Renal artery
  63. The ureter of each kidney conducts urine inferiorly from the kidney to the:
    Bladder.
  64. Accessory organs of the urinary system?
    Ureters, urinary bladder, and urethra.
  65. General function of the urinary system?
    Process (maintain homeostasis of) blood and form urine as a waste to be excreted.
  66. Distinguish between renal cortex and medulla.
    The renal cortex is the outer region of the kidney. The medulla is the inner region of the kidney.
  67. Proportion of heart output that goes through the Kidneys?
    1/5
  68. The mechanism for voiding urine begins with the voluntary relaxation of the:
    External sphincter muscle of the bladder
  69. The capillary network that is fitted neatly into Bowman's capsule is the:
    Glomerulus
  70. The _____ is a structure important in maintaining blood flow because it secretes rennin when blood pressure to the afferent arteriole drops.
    Juxtaglomerular apparatus
  71. Urine is formed by the nephron by means of which three processes?
    Filtration, reabsorption, and secretion
  72. Effective filtration pressure (EFP) is determined by comparing the forces that push fluid into the capillary with those that push:
    Fluid out of the capillary
  73. Reabsorption takes place by means of _____ mechanisms.
    Active and passive transport
  74. The loop of Henle reabsorbs:
    Water, sodium and chloride
  75. _____ has a central role in the regulation of urine volume.
    ADH
  76. Urine is approximately 95%:
    Water
  77. Crystallized mineral chunks that develop in the renal pelvis or calyces are called:
    Kidney stones
  78. The term that describes an inflammation of the bladder is:
    Cystitis
  79. General tissue swelling caused by an accumulation of fluids in the tissue spaces is called a (an):
    Edema
  80. Where does ureter enter bladder and why is its angle important?
    The ureter attaches to the bottom of the bladder and then runs at an angle for about 2 cm through the bladder wall and opens at the lateral angles of the trigone (floor) of the bladder. The ureter’s oblique angle through the bladder wall causes the ends of the tube to close and act as valves when the bladder is full, thus preventing backflow of urine.
  81. What type of epithelium lines most of the urinary tract and what is its advantage?
    Mucous transitional epithelium that forms folds called Rugae. Because of the folds and the extensibility of transitional epithelium, the bladder can distend considerably.
  82. Two major functions of the bladder?
    The bladder serves as a reservoir for urine before it leaves the body and, aided by the urethra, it expels urine from the body.
  83. Name the segments of the nephron in the order in which fluid flows through them.
      1. Renal corpuscle
      2. Bowman capsule
      3. Proximal convoluted tubule
      4. Loop of Henle
      5. Distal convoluted tubule
      6. Collecting duct
  84. Three basic processes a nephron uses to form urine?
    Filtration, tubular reabsorption, and tubular secretion.
  85. What is GFR and why is it important to kidney function?
    Glomerular filtration rate is directly proportional to the effective filtration rate. When the GFR is low, filtration decreases.
  86. How does BP affect filtration in the kidney?
    A decrease in blood pressure tends to produce a decrease in both the glomerular pressure and the glomerular filtration rate.
  87. How are NaCl and water reabsorbed in the proximal convoluted tubule?
    Sodium ions (Na+) are pumped from tubule cell to interstitial fluid, increasing Na+ concentration to a level that drives diffusion of Na+ into blood. As Na+ is pumped out of the cell, more Na+ passively diffuses in from filtrate to maintain equilibrium of concentration. Enough Na+ moves out of the tubule and into blood that an electrical gradient is established (blood is positive relative to filtrate). Electrical attraction between oppositely charged particles drives diffusion of negative ions in filtrate, such as chloride (Cl–), into blood. As ion concentration in blood increases, osmosis of water from the tubule occurs. Thus active transport of sodium creates a situation that promotes passive transport of negative ions and water.
  88. What is sodium cotransport?
    A type of active transport in which the proximal tubules absorb nutrients from the tubule fluid, notably glucose and amino acids, into peritubular blood.
  89. What is a transport maximum?
    The transport maximum of a substance is the maximal capacity for moving any substance limited by availability of carriers.
  90. Characteristics of Glomerular capsule that permit filtration:
    Many pores, or fenestrations, are present in the glomerular endothelium.
  91. Name of blood supply that surrounds the nephron?
    Peritubular blood supply; vasa recta, or “straight arteriole.”
  92. 1. Know the location of the organs of gastrointestinal tract (intra or retroperitoneal)
    • Intraperitoneal
      • Liver
      • Stomach
      • Transverse Colon
      • Small intestine
    • Retroperitoneal
      • Pancreas
      • Duodenum
      • Rectum (Titi: colon)
      • Kidneys (urinary, not gastrointestinal)
  93. 2.1 Gallbladder functions?
      1. Store bile that enters it by way of hepatic and cystic ducts.
      2. Concentrate held bile five- to ten-fold.
      3. Eject bile into duodenum when digestion occurs in the stomach and intestines.
    • Bile salts and lecithin, components of bile, facilitate the emulsification of fats for digestion.
  94. 2.2 What is the surgical removal of gallbladder.
    • Cholecystectomy
  95. 2.3 What is Cholecystitis?
    • Gall Stones or infection…
  96. 3. What gallbladder hormone stimulates bile release?
    • CCK (cholecystokinin) and Secretin
  97. 4. How does bile facilitate fat emulsification?
    • It, and lecithin (both phospholipids), mechanically break up large drops into smaller ones by forming micelles around smaller drops. These phospholipids are arranged so that their water-loving heads are outward, which also makes the smaller fat droplets water soluble.
  98. 5. Know the steps of starch digestion.
      1. Starch (polysaccharide or carbohydrate) digestion begins to some degree in the mouth where it is mixed with saliva containing amylase, which can hydrolyze them into disaccharides. But the time available to salivary amylase before it is destroyed by stomach acids and enzymes make this function relatively unimportant.
      2. Therefore, it is mostly pancreatic amylase that completes the hydrolysis to disaccharides in the intestine.
      3. There, “brush border” enzymes, sucrase, lactase, and maltase bond to the disaccharides and further hydrolyze them into monosaccharaides (mostly glucose)where they can be immediately absorbed, e.g. contact digestion.
  99. 6. Know the steps of protein digestion.
    • Proteins, large molecules of amino acids are
      1. Hydrolyzed into intermediate compounds called Peptides & Proteoses by an army of proteases:
        • Pepsin in gastric juice.
        • Trypsin & Chymotrypsin in pancreatic juice.
        • Peptidases from the intestinal brush border
      2. Finally, more unique proteases - depending on the type of peptide bond to be broken will further hydrolyze these intermediate compounds into amino acids.
      3. As with sodium and glucose, these are absorbed into the blood via sodium cotransport into the intestinal epithelium and then passively into the capillaries.
  100. 7. Know the steps of carbohydrate digestion and the final products.
      • Starting with polysaccharides which contain many saccharide groups (C6H10O5) we have:
        • Starches
        • Glycogen
        Disaccharides:
        • Sucrose
        • Lactose
        • Maltose
        Finally Monosaccharides:
        • Glucose
        • fructose
        • Galactose
  101. 8. Know how the glucose is absorbed into intestinal epithelial cells.
    • Sodium (Na+) cotransport.
  102. 9. Know the histology of alimentary canal and be able to list the layers.
      1. Mucosa Mucus, enzymes & ectopic hormones
      2. Sub Mucosa Blood & Lymphatic vessels, with nerves in Connective tissue
      3. Thick layer of Muscularis consisting of 2 layers
        • Inner Circular, which becomes a sphincter in some locations, and serves both Peristalsis and Segmentation
        • Outer Longitudinal
  103. 10. Know the phases of gastric (stomach) secretion.
      1. Cephalic triggered by sight, smell, taste or thought. Vagal nerve impulses also stimulate endocrine G cells in gastric mucosa to secrete gastrin, which stimulates gastric secretion.
      2. Gastric stretch reflexes in stomach release 2/3 of the gastric juice. Products of protein digestion that have reached the pyloric portion of the stomach stimulate its mucosa to secrete gastrin where after circulating to the gastric glands greatly accelerates the secretion of gastric juice, high in pepsinogen and HCl.
      3. Intestinal has both a brief excitatory phase, and an inhibitory phase for gastric secretions. Chyme with fats, carbohydrates and acid in the duodenum inhibit gastric secretions via GIP, secretin, and CCK. Also, the enterogastric reflex, which reduces gastric peristalsis, may also inhibit gastric secretions.
  104. Gastrin: Source & Action:
    Formed by gastric mucosa in presence of partially digested proteins, when stimulated by the vagus nerve, or when the stomach is stretched.

    Stimulate secretion of gastric juice rich in pepsin and hydrochloric acid.
  105. Secretin: Source & Action:
    Formed by intestinal mucosa in presence of glucose, fats, and perhaps other nutrients.

    Inhibits gastric secretion; stimulates secretion of pancreatic juice low in enzymes and high in alkalinity (bicarbonate); stimulates ejection of bile by the gallbladder.
  106. Gastric Inhibitory Peptide (GIP): Source & Action:
    Formed by intestinal mucosa in presence of glucose, fats, and perhaps other nutrients.

    Inhibits gastric secretion and motility; enhances insulin secretion by pancreas.
  107. Cholecystokinin (CCK): Source & Action:
    Formed by intestinal mucosa in presence of fats, partially digested proteins, and acids.

    Stimulates ejection of bile from gallbladder and secretion of pancreatic juice high in enzymes; opposes the action of gastrin, raising the pH of gastric juice.
  108. 11. Know the unique features of the mucosa of stomach; 5 basic cell types; what do they produce.
    • Titi:
      1. Cardius portion: mucus & HCl
      2. Pyloris
      3. Parietal HCl (needed to activate pepsinogen) and Intrinsic Factor, that binds with vitamin B12 to protect it from digestive juices until it reaches the SI.
      4. Endocrine
      5. Mother & Stem Cells
      BOOK:
      1. Mucus – digestive enzymes and HCl
      2. Chief – enzymes of gastric juice
      3. Parietal – HCl & Intrinsic factor
      4. Endocrine – ghrelin (GHRL) a hormone that stimulates the hypothalamus to secret growth hormone and increase appetite, as well as gastrin.
  109. 12. Know the anatomical parts of the stomach.
      • Cardius – near heart and esophagus at the LES or Lower Esophageal Sphincter.
      • Fundus – dome shape to the left of esophageal opening
      • Body – middle with three layers of musculature: oblique, circular and longitudinal.
      • Pylorus – near the opening to the duodenum, lined with “Rugae” and aligned toward the pyloric sphincter.
  110. 13. Be able to tell what the condition of heartburn (acid reflux) and hiatal hernia represent, the factors which can aggravate the conditions.
    • Heartburn is the backward flow of stomach acid up into the esophagus. Hiatal Hernia is a weakening of the LES (lower esophageal sphincter) such that part or even all of the stomach can protrude into the thoracic cavity. This condition also causes GERD. Causes are:
      • Smoking
      • Obesity
      • Spicy Food
      • Coffee
  111. 14. Know the anatomical parts of the small intestine.
      • Duodenum, 25 cm (10”)
      • Jejunum, 2.5 m (8’) – primary site of absorption & digestion
      • Ileum, 3.5 m (12’) – absorbs vitamins & electrolytes
  112. 15. Know the anatomical parts of the large intestine.
      1. Cecum, 5-8 cm 0 blind pouch
      2. Ascending Colon
      3. Hepatic or Right Colic Flexure
      4. Transverse Colon
      5. Splenic or Left Colic Flexure
      6. Descending Colon
      7. Sigmoid Colon
      8. Rectum, 7-8”
      9. Anal Canal, 1”, with 2 sphincters
  113. 16. Know the lobes of the liver.
      • Left
      • Right
      • Caudate (posterior next to inferior vena cava)
      • Quadrate (anterior, next to gallbladder)
  114. 17. Know the components of the portal triad.
      • Hepatic Artery
      • Hepatic Portal vein
      • Bile Duct
  115. 18. Know the circulation of blood in the liver.
    • Blood flows FROM portal triad TO central vein.
  116. 19. Know how the bile flows (the ducts).
    • Bile flows from hepatocytes in the liver lobule through Bile Canaliculi to the Bile Ducts in the Portal Triad to:
      • Left & Right hepatic Ducts to
      • Common hepatic Duct where it meets bile from delivered from or to) the
      • Cystic Duct, then joins the
      • Common Bile Duct, which joins the Pancreatic Duct the form the
      • Hepatopancreatic Ampulla before emptying into the duodenum through the
      • Major Duodenal Papilla.
  117. 20. The role of enzymes in the process of digestion.
    • These are Inorganic catalysts which speed up the digestion process.
  118. 21. Know the exocrine functions of the pancreas (the components of pancreatic juice)
    • Digestive enzymes are secreted by Acinar cells in the form of zymogens or inactive enzymes and contain:
      1. Proteases for proteins
      2. Lipases (for fat digestion)
      3. Amylases (pancreatic for carbohydrates)
      Duct cells secrete a watery, bicarbonate-rich solution to neutralize the acidity of chime.
  119. 22.1 Hiatal Hernia:
    • Weakening or stretching of the LES (lower esophageal sphincter), which is intrinsic to the esophageal hiatus through the diaphragm. This can allow part or all of the stomach up into the thoracic cavity.
  120. 22.2 Gastric Ulcer:
    • Erosion of the stomach wall. Most ulcers are caused by an infection with spiral-shaped bacterium Helicobacter pylori, NOT excess stomach acid.
  121. 22.3 Hemorrhoids:
    • Varicose veins of the anus.
  122. 22.4 Constipation:
    • Excess water absorption leading to dry packed feces.
  123. 22.5 Diarrhea:
    • Decreased water and electrolyte absorption in the SI resulting from increased motility.
  124. 22.6 Peritonitis:
    • Inflammation of the covering of the organs of the abdominal cavity.
  125. 23. Know the functions of the urinary system.
    • Primary – regulation of
      • Blood Volume, i.e. BP
      • Chemical makeup of blood
      Secondary
      • Metabolism of Vitamin D
      • Production of Renin, which is released by JG (Juxtaglomerular cells) by detection of the increased reabsorption of Na+ & Cl-, resulting from decreased arterial BP. Renin sets in motion the release of a vasoconstrictor to raise BP.
      • Production of EPO (erythropoietin) to stimulate RBC generation.
      • Gluconeogenesis from amino acids and possibly fatty acids. Though primarily a liver process, it does occur in the cortex of the kidneys.
  126. 24.1 Be able to trace urine flow.
      • Renal papilla of medullary pyramid.
      • Minor Calyces
      • Major Calyces
      • Renal Pelvis.
      • Ureter
      • Bladder
      • Urethra
  127. 24.2 Normal urine contents.
      • 95% water
      • 5% solutes
        • Uric acid from nucleic acid breakdown.
        • Creatinine from skeletal muscles
        • Urea from protein catabolism
        • Ions: Na+, K+, Cl-, Ca, Mg, and HCO3-
  128. 25.1 Know the blood supply to the kidneys.
      1. Abdominal aorta
      2. Renal arteries
      3. (5) Segmental arteries
      4. Lobar and then Interlobar arteries
      5. Arcuate arteries, which arch over the base of the renal pyramids
      6. Interlobar radiate arteries to Renal Cortex
      7. Afferent arterioles (larger lumen than efferent)
      8. Glomerulus
      9. Efferent arterioles
      10. Peritubular capillaries or vasa recta
      11. Interlobular veins, etc. (Note: there are no "lobar" or "segmental" veins)
  129. 25.2 What is a “Renal Corpuscle”?
      • Bowman Capsule plus the Glomerulus
  130. 26. Know the role of the nephron as the functional unit of kidney.
    • It is THE site of:
      • Filtration
      • Reabsorption
      • Secretion
    • It is composed of:
      • The Renal Corpuscle (Bowman Capsule & Glomerulus)
      • PCT (Proximal Convoluted Tubule)
      • Loop of Henle
      • DCT (Distal Convoluted Tubule)
      • CD (Collecting Ducts)
  131. 27. Know the processes, which result in the formation of urine.
      • Filtration
      • Reabsorption
      • Secretion
  132. 28. Know the mechanisms and pressures involved in the process of filtration.
      • The primary driving force behind filtration is Hydrostatic pressure specifically of the Glomerulus. But the Glomerular osmotic Pressure and Capsular (Bowman) Hydrostatic Pressure have an impact on the Effective Filtration Pressure
      • The smaller lumen of the Efferent Arteriole (compare to the Afferent Arteriole boosts the pressure in the Glomerulus to about 80 mm Hg.
  133. 29. Know the processes of reabsorption and secretion; the mechanisms involved; role of the sodium in tubular reabsorption.
      • Major portion of water & electrolytes and (normally) all nutrients are reabsorbed in the PCT.
      • Na+ is reabsorbed via active transport (requires ATP). It has the following effects:
        1. Creates an electrical gradient, which passively pulls negative ions such as chloride (Cl-) and phosphate (PO4-3)
        2. As the ions concentration increases in the Interstitial fluid and peritubular blood, an Osmotic gradient is also created, which creates an obligatory reabsorption of water.
        3. Along with the active transport of Na+, glucose and amino acids bind to the Na+ and are reabsorbed via sodium cotransport
  134. 30. Know the process of transport maximum (saturation) in the reabsorption of a substance.
      • The ability to move glucose back into the peritubular blood from the nephron is limited by the number of cotransport carriers; in this case sodium. This limit is the transport maximum.
      • It is the highest concentration of a substance before it cannot be reabsorbed due to limited protein carriers and it appears in the blood (should be urine).
      • Normal blood glucose is 70-110 mg/Dl. Tmax or saturation is 180 per Titi, but about 300 per book.
  135. 31.1 Hypoalbuminemia:
    • Albumin, the most abundant plasma protein, never normally leaves blood plasma. But with Hypoalbuminemia – holes in damaged glomeruli, it is secreted in the urine and results in low oncotic pressure (protein osmosis gradient) resulting in widespread edema because of water leaving the blood stream.
  136. 31.2 Nephritis:
    • Is a general term referring to kidney disease; especially inflammatory conditions. More specifically is Pyelonephritis (pelvis nephritis), or inflammation of the renal pelvis.
  137. 31.3 Renal failure:
      • Cannot eliminate UREA, a nitrogen–containing waste product from the catabolism of proteins. Diagnosed via high BUN (blood urea nitrogen) Renal failure can be acute or chronic.
      • See also AZA…EMIA - nitrogen on the blood.
  138. 31.4 Urethritis:
    • An inflammation of the urethra that is commonly the result of a bacterial infection, often gonorrhea. Nongonococcal infections are usually Chlamydia. Males suffer more often than females.
  139. 31.41 Uremia:
      • Titi: “Toxins of meat digestion”. Book indicates that it is essentially high UREA in the blood.
      • An indication of some failure of the kidneys.
  140. 31.5 Lithotripsy:
    • Ultrasonic waves via “Lithotriptor” to dissolve kidney stones.
  141. 31.6 Acute glomerulonephritis:
    • the most common form of kidney disease. It may be caused by a delayed immune response to a streptococcal infection – the same mechanism that causes damage to heart valves in rheumatic heart disease. For this reason, it is sometimes called postinfectious glomerulonephritis.
  142. 31.7 Cystitis:
    • Infection of the urinary bladder. (It is a “cyst” like the gallbladder.)
  143. 31.8 Renal calculi:
    • Or Kidney Stones, these are crystallized mineral chunks that develop in the renal pelvis or calyces.
  144. 32.1 Proteinuria:
    • Presence of proteins (especially albumin) in the urine. It abnormally leaves the blood through damage glomeruli and is not reabsorbed by the kidney tubules.
  145. 32.2 Pyuria:
    • ”Milky urine” from pus
  146. 32.3 Oliguria:
    • Reduced urine formation. Titi: less than 1 liter/day
  147. 32.4 Glycosuria:
    • Glucose in the urine; a sign of diabetes mellitus.
  148. 32.5 Incontinence:
    • Involuntary voiding of urine. Usually from loss of nervous control (stroke or accident), e.g. neurogenic bladder.
  149. 32.6 Anuria:
    • NO urine. From dehydration, renal failure or obstruction.
  150. 32.7 Ketonuria:
    • Medical condition in which ketone bodies are present in the urine. It is seen in conditions in which the body produces excess ketones as an alternative source of energy. It is seen during starvation or more commonly in type I diabetes mellitus. Production of ketone bodies is a normal response to a shortage of glucose, meant to provide an alternate source of fuel from fatty acid.
  151. 32.8 Hematuria:
      • Blood in urine – likely cause: cancer.
      • It may be idiopathic and/or benign, or it can be a sign that there is a kidney stone or a tumor in the urinary tract (kidneys, ureters, urinary bladder, prostate, and urethra), ranging from trivial to lethal. If white blood cells are found in addition to red blood cells, then it is a signal of urinary tract infection.
  152. 32.9 Polyuria:
    • Unusually large amounts (or frequent) urination.
  153. 32.10 Dysuria:
    • Painful urination, usually indicative of an infection
  154. 33. Know the characteristics of mucosa of urinary bladder.
      1. The inner-most layer of the bladder is the mucosa, which is composed of transitional epithelial cells, which are extensible. In addition to this capability, the mucosa is formed into Rugae, or folds, that give it further ability to stretch. There is a submucosal layer as well.
      2. The 2nd layer is a thick Muscularis of smooth muscle with bundles running in all directions. It is often called detrusor muscle.
      3. The 3rd layer is an adventitia of connective tissue.
      4. the outermost layer is the serosa, a retroperitoneum, lying under the parietal peritoneum.
  155. 34. Know the process of micturition.
      • a.k.a. urination or voiding the bladder. 200 ml triggers stretch receptors, which signal the micturation center of the PONS, an ANS controlled parasympathetic outflow to the bladder to relax the internal (smooth) urinary bladder sphincter and contraction of the detrusor muscle.
      • Our (somatic) control of the external (skeletal) sphincter is the check on this autonomic response.

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