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Urinary System abdominal distention

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					                                      Urinary System

Introduction
A.     The urinary system consists of two kidneys that filter the blood, two ureters, a
       urinary bladder, and a urethra to convey waste substances to the outside.

Kidneys
A.    The kidney is a reddish brown, bean-shaped organ 12 centimeters long; it is
      enclosed in a tough, fibrous capsule.

B.     Kidney Structure
       1.    A medial depression in the kidney leads to a hollow renal sinus into which
             blood vessels, nerves, lymphatic vessels, and the ureter enter.
       2.    Inside the renal sinus lies a renal pelvis that is subdivided into major and
             minor calyces; small renal papillae project into each minor calyx.
       3.    Two distinct regions are found within the kidney: a renal medulla and a
             renal cortex.
             a.      The renal medulla houses tubes leading to the papillae.
             b.      The renal cortex contains the nephrons, the functional units of the
                     kidney.

C.     Location of the Kidneys
       1.     The kidneys are positioned retroperitoneally on either side of the
              vertebral column between the twelfth thoracic and third lumbar vertebrae.

D.     Kidney Functions
       1.    The kidneys function to regulate the volume, composition, and pH of
             body fluids and remove metabolic wastes from the blood in the process.
       2.    The kidneys also help control the rate of red blood cell formation by
             secreting erythropoietin, and regulate blood pressure by secreting renin.

E.     Renal Blood Vessels
       1.    The abdominal aorta gives rise to renal arteries leading to the kidneys.
       2.    As renal arteries pass into the kidneys, they branch into successively
             smaller arteries: interlobar arteries, arcuate arteries, interlobular arteries,
             and afferent arterioles leading to the nephrons.
       3.    Venous blood is returned through a series of vessels that generally
             correspond to the arterial pathways.

F.     Nephrons
       1.    Nephron Structure
             a.    A kidney contains one million nephrons, each of which consists
                   of a renal corpuscle and a renal tubule.
               b.      The renal corpuscle is the filtering portion of the nephron; it is
                       made up of a ball of capillaries called the glomerulus and a
                       glomerular capsule that receives the filtrate.
               c.      The renal tubule leads away from the glomerular capsule and first
                       becomes a highly coiled proximal convoluted tubule, then leads to
                       the nephron loop, and finally to the distal convoluted tubule.
               d.      Several distal convoluted tubules join to become a collecting duct.

       2.      Blood Supply of a Nephron
               a.    The glomerulus receives blood from a fairly large afferent arteriole
                     and passes it to a smaller efferent arteriole.
               b.    The efferent arteriole gives rise to the peritubular capillary system,
                     which surrounds the renal tubule.

       3.      Juxtaglomerular Apparatus
               a.      At the point of contact between the afferent and efferent arterioles
               and the distal convoluted tubule, the epithelial cells of the distal
               tubule form the macula densa.
               b.      Near the macula densa on the afferent arteriole are smooth muscle
                       cells called juxtaglomerular cells.
               c.      The macula densa together with the juxtaglomerular cells make up
                       the juxtaglomerular apparatus.

Urine Formation
A.    Urine formation involves glomerular filtration, tubular reabsorption, and tubular
      secretion.

B.     Glomerular Filtration
       1.   Urine formation begins when the fluid portion of the blood is filter by the
            glomerulus and enters the glomerular capsule as glomerular filtrate.

C.     Filtration Pressure
       1.      The main force responsible for moving substances by filtration through the
               glomerular capillary wall is the hydrostatic pressure of the blood inside.
       2.      Due to plasma proteins, osmotic pressure of the blood resists filtration, as
               does hydrostatic pressure inside the glomerular capsule.

D.     Filtration Rate
       1.      The factors that affect the filtration rate are filtration pressure, glomerular
               plasma osmotic pressure, and hydrostatic pressure in the glomerular
               capsule.
       2.      When the afferent arteriole constricts in response to sympathetic
               stimulation, filtration pressure, and thus filtration rate, declines.
       3.      When the efferent arteriole constricts, filtration pressure increases,
               increasing the rate of filtration.
     4.     When osmotic pressure of the glomerular plasma is high, filtration rate
            decreases.
     5.     When hydrostatic pressure inside the glomerular capsule is high, filtration
            rate declines.
     6.     On the average, filtration rate is 125 milliliters per minute or 180 liters in
            24 hours, most of which is reabsorbed further down the nephron.

E.   Regulation of Filtration Rate
     1.    Glomerular filtration rate is relatively constant, although sympathetic
           impulses may decrease the rate of filtration.
     2.    Another control over filtration rate is the renin-angiotensin system, which
           regulates sodium excretion.
           a.      When the sodium chloride concentration in the tubular fluid
                   decreases, the macula densa senses these changes and causes the
                   juxtaglomerular cells to secrete renin.
           b.      Secretion of renin triggers a series of reactions leading to the
                   production of angiotensin II, which acts as a vasoconstrictor;
                   this may, in turn, affect filtration rate.
           c.      Presence of angiotensin II also increases the secretion of
                   aldosterone, which stimulates reabsorption of sodium.
           d.      The heart can also increase filtration rate when blood volume
                   is high.

F.   Tubular Reabsorption
     1.    Changes in the fluid composition from the time glomerular filtrate is
           formed to when urine arrives at the collecting duct are largely the result of
           tubular reabsorption of selected substances.
     2.    Most of the reabsorption occurs in the proximal convoluted tubule, where
           cells possess microvilli with carrier proteins.
     3.    Carrier proteins have a limited transport capacity, so excessive amounts of
           a substance will be excreted into the urine.
     4.    Glucose and amino acids are reabsorbed by active transport, water by
           osmosis, and proteins by pinocytosis.

G.   Sodium and Water Reabsorption
     1.    Sodium ions are reabsorbed by active transport, and negatively charged
           ions follow passively.
     2.    As sodium is reabsorbed, water follows by osmosis.

H.   Regulation of Urine Concentration and Volume
     1.    Most of the sodium ions are reabsorbed before the urine is excreted, and
           sodium is concentrated in the renal medulla by the countercurrent
           mechanism.
     2.    Normally the distal convoluted tubule and collecting duct are impermeable
           to water unless the hormone ADH is present.
I.     Urea and Uric Acid Excretion
       1.    Urea is a by-product of amino acid metabolism; uric acid is a by-product
             of nucleic acid metabolism.
       2.    Urea is passively reabsorbed by diffusion but about 50% of urea is
             excreted in the urine.
       3.    Most uric acid is reabsorbed by active transport and a small amount is
             secreted into the renal tubule.

J.     Tubular Secretion
       1.    Tubular secretion transports certain substances from the plasma into the
             renal tubule.
       2.    Active transport mechanisms move excess hydrogen ions into the renal
             tubule along with various organic compounds.
       3.    Potassium ions are secreted both actively and passively into the distal
             convoluted tubule and the collecting duct.

K.     Urine Composition
       1.    Urine composition varies from time to time and reflects the amounts of
             water and solutes that the kidneys eliminate to maintain homeostasis.
       2.    Urine is 95% water, and also contains urea, uric acid, a trace of amino
             acids, and electrolytes.

Urine Elimination
A.     After forming in the nephrons, urine passes from the collecting ducts to the renal
       papillae, then to the minor and major calyces, and out the renal pelvis to the
       ureters, urinary bladder, and finally to the urethra, which conveys urine to the
       outside.

B.     Ureters
       1.    The ureters are muscular tubes extending from the kidneys to the base
             of the urinary bladder.
       2.    The wall of the ureter is composed of three layers: mucous coat, muscular
             coat, and outer fibrous coat.

D.     Micturition
       1.      Urine leaves the bladder by the micturation reflex.
       2.      The detrusor muscle contracts and the external urethral sphincter (in the
               urogenital diaphragm) must also relax.
       •Stretching of the urinary bladder triggers the micturation reflex center located in
       the sacral portion of the spinal cord.
       4.      Return parasympathetic impulses cause the detrusor muscle to contract in
               waves, and an urge to urinate is sensed.
       5.      When these contractions become strong enough, the internal urethral
               sphincter is forced open.
       6.      The external urethral sphincter is composed of skeletal muscle and is
               under conscious control.

E.     Urethra
       1.    The urethra is a tube that conveys urine from the urinary bladder to the
             outside.
       2.    It is a muscular tube with urethral glands that secrete mucus into the
             urethral canal.

                       Water, Electrolyte, and Acid-Base Balance

Introduction
A.     To be in balance, the quantities of fluids and electrolytes leaving the body should
       be equal to the amounts taken in.

B.     Anything that alters the concentrations of electrolytes will also alter the
       concentration of water, and vice versa.

Distribution of Body Fluids
A.     Fluids occur in compartments in the body, and movement of water and
       electrolytes between compartments is regulated.

B.     Fluid Compartments
       1.     The average adult female is 52% water by weight, while a male is 63%
              water, the difference due to the female's additional adipose tissue.
       2.     The intracellular fluid compartment includes all the water and electrolytes
              within cells.
       3.     The extracellular fluid compartment includes all water and electrolytes
              outside of cells (interstitial fluid, plasma, and lymph).
       4.     Transcellular fluid includes the cerebrospinal fluid of the central
              nervous system, fluids within the eyeball, synovial fluid of the joints,
              serous fluid within body cavities, and exocrine gland secretions.

C.     Body Fluid Composition
       1.    Extracellular fluids have high concentrations of sodium, chloride, and
             bicarbonate ions, and lesser amounts of potassium, calcium, magnesium,
             phosphate, and sulfate ions.
       2.    Intracellular fluid has high concentrations of potassium, phosphate,
             and magnesium ions, and lesser amounts of sodium, chloride, and
             bicarbonate ions.

D.     Movement of Fluid between Compartments
       1.   Hydrostatic pressure and osmotic pressure regulate the movement of
            water and electrolytes from one compartment to another.
       2.      Although the composition of body fluids varies from one compartment to
               another, the total solute concentrations and water amounts are normally
               equal.
       3.      A net gain or loss of water will cause shifts affecting both the intracellular
               and extracellular fluids due to osmosis.

Water Balance
A.    Water balance exists when water intake equals water output.

B.     Water Intake
       1.     The volume of water gained each day varies from one individual to the
              next.
       2.     About 60% of daily water is gained from drinking, another 30% comes
              from moist foods, and 10% from the water of metabolism.

C.     Regulation of Water Intake
       1.    The thirst mechanism is the primary regulator of water intake.
       2.    The thirst mechanism derives from the osmotic pressure of extracellular
             fluids and a thirst center in the hypothalamus.
       3.    Once water is taken in, the resulting distention of the stomach will inhibit
             the thirst mechanism.

D.     Water Output
       1.    Water is lost in urine, feces, perspiration, evaporation from skin
             (insensible perspiration), and from the lungs during breathing.
       2.    The route of water loss depends on temperature, relative humidity, and
             physical exercise.

E.     Regulation of Water Output
       1.    The distal convoluted tubules and collecting ducts of the nephrons
             regulate water output.
       2.    Antidiuretic hormone from the posterior pituitary causes a reduction in
             the amount of water lost in the urine.
       3.    When drinking adequate water, the ADH mechanism is inhibited, and
             more water is expelled in urine.

Electrolyte Balance
A.     An electrolyte balance exists when the quantities of electrolytes gained equals the
       amount lost.

B.     Electrolyte Intake
       1.     The electrolytes of greatest importance to cellular metabolism are sodium,
              potassium, calcium, magnesium, chloride, sulfate, phosphate,
              bicarbonate, and hydrogen ions.
       2.     Electrolytes may be obtained from food or drink or produced as a by-
              product of metabolism.
C.     Regulation of Electrolyte Intake
       1.    A person ordinarily obtains sufficient electrolytes from foods eaten.
       2.    A salt craving may indicate an electrolyte deficiency

D.     Electrolyte Output
       1.     Losses of electrolytes occur through sweating, in the feces, and in urine.

E.     Regulation of Electrolyte Output
       1.    The concentrations of the cations, especially sodium, potassium, and
             calcium, are very important.
       2.    Sodium ions account for 90% of the positively charged ions in
             extracellular fluids; the action of aldosterone on the kidneys regulates
             sodium reabsorption.
       3.    Aldosterone also regulates potassium ions; potassium ions are excreted
             when sodium ions are conserved.
       4.    Calcium concentration is regulated by parathyroid hormone, which
             increases the concentrations of calcium and phosphate ions in extracellular
             fluids and by calcitonin which does basically the reverse.
       5.    Generally, the regulatory mechanisms that control positively charged ions
             secondarily control the concentrations of anions.

Acid-Base Balance
A.    Electrolytes that ionize in water and release hydrogen ions are acids; those that
      combine with hydrogen ions are bases.

B.     Maintenance of homeostasis depends on the control of acids and bases in body
       fluids.

C.     Sources of Hydrogen Ions
       1.    Most hydrogen ions originate as by-products of metabolic processes,
             including: the aerobic and anaerobic respiration of glucose, incomplete
             oxidation of fatty acids, oxidation of amino acids containing sulfur, and
             the breakdown of phosphoproteins and nucleic acids.

D.     Strengths of Acids and Bases
       1.     Acids that ionize more completely are strong acids; those that ionize less
              completely are weak acids.
       2.     Bases release hydroxyl and other ions, which can combine with hydrogen
              ions, thereby lowering their concentration.

E.     Regulation of Hydrogen Ion Concentration
       1.    Acid-base buffer systems, the respiratory center in the brain stem, and
             the kidneys regulate pH of body fluids.
       2.    Acid-Base Buffer Systems
             a.      The chemical components of a buffer system can combine with a
                     strong acid and convert it to a weaker one.
              b.     The chemical buffer systems in body fluids include the bicarbonate
                     buffer system, the phosphate buffer system, and the protein buffer
                     system.
       3.     The Respiratory Center
              a.     The respiratory center in the brain stem helps to regulate hydrogen
                     ion concentration by controlling the rate and depth of breathing.
              b.     During exercise, the carbon dioxide, and thus the carbonic
                     acid, levels in the blood increase.
              c.     In response, the respiratory center increases the rate and depth of
                     breathing, so the lungs excrete more carbon dioxide.
       4.     The Kidneys
              a.     Nephrons secrete excess hydrogen ions in the urine.
       5.     Rates of Regulation
              a.     Chemical buffers are considered the body's first line of defense
                     against shifts in pH; physiological buffer systems (respiratory and
                     renal mechanisms) function more slowly and constitute secondary
                     defenses.

Acid-Base Imbalances
A.    Chemical and physiological buffer systems usually keep body fluids within very
      narrow pH ranges but abnormal conditions may prevent this.
      1.      A pH below 7.35 produces acidosis while a pH above 7.45 is called
             alkalosis.

B.     Acidosis
       1.     Two major types of acidosis are respiratory and metabolic acidosis.
             a.    Respiratory acidosis results from an increase of carbonic acid
                   caused by respiratory center injury, air passage obstructions of
                   problems with gas exchange.
             b.    Metabolic acidosis is due to either an accumulation of acids of
                   a loss of bases and has many causes including kidney disease,
                   vomiting, diarrhea and diabetes mellitus.
             c.    Increasing respiratory rate or the amount of hydrogen ions
                   released by the kidney can help compensate for acidosis.

C.     Alkalosis
       1.    Alkalosis also has respiratory and metabolic causes.
             a.     Respiratory alkalosis results from hyperventilation causing an
                    excessive loss of carbon dioxide.
             b.     Metabolic alkalosis is caused by a great loss of hydrogen ions or a
                    gain in base perhaps from vomiting or use of drugs.

				
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Description: Urinary System abdominal distention