Fundamentals of Anatomy and Physiology

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Barrett KE, Barman SM, Boitano S, Brooks HL. Ganong's Review of ... Drake RL, Vogl W, Mitchell AWM. Gray's Anatomy for Students. Elsevier,. Philadelphia ...
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University of Baghdad College of Nursing Department of Basic Medical Sciences

Overview of Anatomy and Physioloy –II Second Year Students

Asaad Ismail Ahmad , Ph.D. Electrolyte and Mineral Physiology [email protected] 2012 - 2013

ANATOMY AND PHYSIOLOGY - II Brief Contents 1- Cardiovascular System 2- Blood 3- Lymphatic System 4- Urinary System 5- Male Reproductive System 6- Female Reproductive System 7- Sensory Function Asaad Ismail Ahmad, Ph.D in Electrolyte and Mineral Physiology College of Nursing – University of Baghdad / 2012 – 2013 [email protected]

Text book Martini FH. Fundamentals of Anatomy and Physiology, 5th ed. Prentice Hall, New Jersey, 2001.

References:

1.Barrett KE, Barman SM, Boitano S, Brooks HL. Ganong's Review of Medical Physiology, 23rd ed. McGraw Hill, Boston, 2010. 2.Drake RL, Vogl W, Mitchell AWM. Gray's Anatomy for Students. Elsevier, Philadelphia, 2005. 3.Goldberger ,E. 1975.A Primer of Water Electrolyte and Acid-Base Syndromes. 5th ed., Lea and Febiger ,Philadelphia. 4. Martini, FH and Welch K. Applications Manual Fundamentals of Anatomy and Physiology,4th ed., Prentice Hall, NewJersey, 1998. 5.Maxwell, MH and Kleeman CR. 1980.Clinical Disorders of Fluid and Electrolyte Metabolism. McGraw-Hill Book Company, New York. 6.McKinley M, and O'Loughlin VD. Human Anatomy, McGraw Hill, Boston, 2006. 7.Nutrition Foundation.1984.Present Knowledge in Nutrition. 5th ed., Nutrition Foundation, Inc , Washington, D.C. 8.Vander A, Sherman J, Luciano D., Human Physiology, 7th ed., McGraw Hill, Boston, 1998.

TENTH LECTURE Physiology of Urinary System 1. Urine Formation 2. Micturation 3. Composition of Urine and Urinalysis

Asaad Ismail Ahmad, Ph.D in Electrolyte and Mineral Physiology College of Nursing – University of Baghdad / 2012 – 2013 [email protected]

GENERAL KIDNEYS FUNCTIONS 1-Maintaining volume of body fluids (ECF & ICF) 2-Maintaining composition of body fluids 3-Formation of urine (organization of waste products)

KIDNEYS FUNCTIONS (Formation of Urine)

MECHANISMS OF KIDNEY FUNCTIONS p.953

1234-

FILTRATION REABSORPTION SECRETION EXCRETION

Schematic of relations between blood vessels and tubular structures

FILTRATION

Factors Glomerular Filtration Depends on 1- Pressure gradient across the filtration slit( endothelium, basal membrane, epithelium”podocytes”. 2- Blood circulation through out the kidneys. 3- Permeability of filtration barrier. 4- Filtration surface.

Hormones affecting filtration

1- Antidiuretic hormone (ADH): reabsorption of H2O. 2- Aldosterone: reabsorption of Na+ 3-Atrial natriuretic peptide: decrease reabsorption of Na+

HORMONES EFFECT ON RENAL FUNCTIONS 12345-

ADH ‘Antiduretic hormone’ PTH ‘Parathyroid hormone’ Aldosterone Angeotinsin II ANP ‘ Atrial Natriuretic hormone “

Hormones Secreted by Kidneys 1234-

Renin Erythropoietin (EPO) Calcitriol (Active vitamin D) Prostaglandins

REABSORPTION

Reabsorption – Proximal convoluted tubules 2/3 of filtered salt and water, and all filtered organic solutes (primarily glucose and amino acid) 1- 75 – 80 % water 2- Na+, Cl-, HCO3-, K+ , Ca2++ , Mg2++, HPO4— 3- Glucose and Amino acids

MECHANISMS OF TUBULAR REABSORPTION p.958 12345-

Passive mechanism Active mechanism Paracellular route Diffusion Osmosis

SECRETION

Substances Secreted by Renal Tubules p.965 1- Hydrogen ion (H+) 2- Potassium ion (K+) 3- Organic cation ( OC+) e.g. epinephrine, choline, serotonin, atropine, quinine, cimitidine, morphine, etc 4- Organic anion (OA-) e.g. PAH, phenol red, hippurate, urate, penicillin, barbiturate, diuretics,conjugates, etc

SIGNIFICANT DIFFERENCES BETWEEN SOLUTE CONCENTRATIONS OF URNE AND PLASMA P. 953

RENIN: Proteolytic enzyme synthesized, stored, and secreted by the juxtaglomerular cells of the kidney, it play a role in regulation of blood pressure by catalyzing the conversion of the plasma angeotinsinogen to angeotinsin I. ANGEOTINSIN - I. Convert to angeotinsin II in the lungs . ANGEOTINSIN - II. IS A POTENT VASOCONSTRICTORS , and a powerful stimulus of aldosterone secretion

Structure of the juxtaglomerular apparatusfunction.

Urination (Micturation) Process of disposing urine from urinary bladdder through the urethra to outside the body The process of urination is usually under voluntary control

Urinary incontinence :is the inability to control urination, and is more common in women than men

Urinary retention: is the inability to urinate Nocturia : is the incontenence during the night (effects of emotions)

Micturition Reflex 1- Activated when the urinary bladder wall is stretched, it result in urination. 2- This reflex occur in spinal cord, especially in the sacral region, that is modefied by higher center in the brain, the pons and cerebrum. 3-The presence of urine in the bladder stimulate stretch receptors ,which produces action potential. 4- The action potential is carried by sensory neurons to the sacral segments of the spinal cord through the pelvic nerves, the parasympathetic fibers carry action potentials to the urinary bladder in the pelvic nerves. 5- The pressure in urinary bladder increases rapidly once its volume exceeds approximately 400- 500 ml.

Steps of Micturition 1- Distention of urinary bladder. 2- Stimulation of sensory fiber (afferent),send impulses to micturition center in spinal cord. 3- Stimulation of parasympathetic nerve fiber (motor) to : a- to stimulate detrusor muscle in U.B. b- relax internal urethral sphincter. 4- Sensation for urination as urgent.

Continue: Steps of Micturition 5- Urination prevented by a- contraction of external urethral sphincter. b- inhibition of micturition reflex by cerebral cortex 6- Micturition (urination) occur after decision to a- voluntry relaxation of external urethral sphincter. b- facilitation by impulsee from hypothalamus. 7- Inactivation of micturition reflex center, and relaxation of detrusor muscle

Measurement of renal function A simple means of estimating renal function is to measure pH, blood urea nitrogen, creatinine, and basic electrolytes (including sodium, potassium, chloride, and bicarbonate). As the kidney is the most important organ in controlling these values, any derangement in these values could suggest renal impairment.

Clearance 1- Ability of the kidneys to clear plasma from different products. 2- Glomerular Filtration Rate (GFR ) 3- GFR = U x V / P U = concentration of inulin in urine V = volume of urine P = concentration of inulin in the plasma Normal GFR is around 125 ml/min (7.5 l/h)

Assessing Renal function/ Measures of dialysis 1- Glomerular filtration rate 2- Creatinine clearance 3- Renal clearance ratio 4- Urea reduction ratio 5- Kt/V 6- Standardized Kt/V 7- Hemodialysis product 8- PAH clearance (Effective renal plasma flow Extraction ratio)

Hemodialysis Process p.970

Plugged into dialysis

Urinary Tract Infection

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