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116 Cards in this Set
- Front
- Back
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What regulates the reabsorption of water by the kidneys?
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ADH
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What happens to the collecting duct in the presence of ADH?
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Permeability increases and water is reabsorbed
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What GI symptom is a potent stimulus for the release of ADH?
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Nausea (10-100x)
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What is ARF?
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A rapid, reversible decline in renal function leading to increased blood levels of nitrogenous wastes and impaired fluid and electrolyte imbalances.
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What is the most common indicator of ARF?
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Azotemia (An accumulation of nitrogenous wastes like urea nitrogen, uric acid, and creatinine)
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What characterizes prerenal failure?
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Decreased blood flow
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What characterizes postrenal failure?
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Obstruction of urine outflow from the kidneys.
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What characterizes intrinsic renal failure?
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Damage to structures within the kidney.
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How does one assess the kidney's ability to concentrate urine?
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Urine osmolality, urine sodium concentration, and fractional exertion of sodium
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What physiological process leads to nephrotic syndrome?
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Increased glomerular permeability to the plasma proteins
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What characterizes nephrotic syndrome?
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Massive proteinuria, lipiduria, hypoalbunemia, generalized edema, and hyperlipidemia
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What is the rate of glomerular filtration per minute?
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120-130ml/min
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What kind of acute renal failure is acute tubular necrosis?
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Intrinsic renal failure
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What causes acute tubular necrosis?
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Destruction of tubular epithelial cells with acute suppression of renal function
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How does ATN contrast to prerenal failure?
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GFR does not improve with restoration of blood flow
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What are the common characteristics of ATN?
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A decrease in GFR, increased metabolites like urea, potassium, sulfate, and creatinine; fluid retention (edema, water intoxification, and pulmonary congestion), HTN, and hyperkalemia
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What is one of the earlest manifestations of tubular damage?
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The inability to concentrate urine
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What is the first step in the treatment of ARF? What other steps are taken?
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Identifying and correcting the cause. Fluid regulation, adequate caloric intake, and dialysis or CRRT
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What is the rate of urine production per minute?
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1ml/min of GFR
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What percentage of GFR is lost in someone with renal insufficiency?
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20-50% of normal GFR
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What is the earliest sign of renal insufficiency?
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Isosthenuria (polyuria with urine that is almost isotonic with plasma)
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What percentage of GFR is present in people with renal failure?
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Less than 20%
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What failure occurs in the kidneys and what clinical symptoms occur?
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Impaired volume regulation and solute composition, edema, metabolic acidosis, and hyperkalemia
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What is the GFR in people with ESRD?
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Less than 5% or less than 15ml/min per 1.73m2
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Why does pH decrease in persons with renal failure?
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The kidneys regulate pH by excreting hydrogen ions and regenerating bicarbonate
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Why does acidosis in elderly people with CRF stabilize?
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Buffering capacity of bone although this can lead to skeletal disorders
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What blood test is used to measure GFR and renal function?
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Serum creatinine
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Can blood buffer systems of the respiratory system eliminate hydrogen ions?
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No. Hydrogen ion elimination is strictly renal
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What are the 3 major urine buffers?
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Bicarbonate, phosphate, and ammonia
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What is formed by the combination of bicarbonate and hydrogen ions?
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Carbon dioxide and water
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Why is creatinine useful in measuring GFR?
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Creatinine is normally filtered by kidneys but not reabsorbed.
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When renal blood flow decreases, what hormone is released and ultimately responsible for the HTN seen?
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Renin is released which stimulates the production of angiotensin II which is a potent vasoconstrictor
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When HTN leads to thickening of glomerulus and perfusion decreases, what happens to the nephron and ultimately, urine?
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Blood supply to the nephron decreases causing an inability to concentrate urine. This may present as nocturia.
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What is an early manifestation of CRF?
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HTN
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What symptom is common in obstructive jaundice?
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Pruritus
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Why is the liver subject to injury from drugs and environmental agents?
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It is central to the metabolism of virtually all drugs and foreign substances
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What is portal hypertension?
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A resistance to blood flow in the portal venous system above 12mmHg
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What is the characteristic appearance of Crohn's disease?
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A "cobblestone" appearance with fissures and submucosal edema
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What are the main symptoms of Crohn's disease?
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Intermittent diarrhea, colicky pain, weight loss, fluid & electrolyte disorders, malaise, and low-grade temp.
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What happens to someone when they lack lactase?
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They are unable to break down lactose when they ingest milk products and have diarrhea
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What actions can increase the severity of GERD symptoms?
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Bending at the waist, lying in the recumbent position
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What are the proposed mechanisms of reflux-associated asthma and chronic cough?
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Macroaspiration, microaspiration, laryngeal injury, and vagal-mediated bronchospasm
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What are some complications of GERD?
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Erosion, hyperemia, edema and strictures called Barrett's esophagus (scar tissue, spasm, and edema)
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What is the renal compensation for respiratory alkalosis?
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Decrease H+ excretion and decrease HCO3 reabsorption
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What is GERD associated with?
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A weak or incompetent lower espophageal sphincter
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What is the most frequent symptom of GERD?
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Severe heartburn followed by frequent belching and chest pain
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What is the renal compensation for metabolic alkalosis?
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Decreased H+ excretion and decreased HCO3 reabsorption
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What is the primary disturbance in respiratory acidosis?
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An increase in pCO2
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What is the renal compensation for respiratory acidosis?
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Increased H+ excretion and increased bicarbonate reabsorption
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What is the primary disturbance in respiratory alkalosis?
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A decrease in pCO2
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What is the primary disturbance in metabolic acidosis?
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A decrease in HCO3
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What is the respiratory compensation for metabolic acidosis?
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Hyperventilation to decrease pCO2
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What is the renal compensation for metabolic acidosis?
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An increase in H+ excretion and an increase in HCO3 reabsorption
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What is the primary disturbance in metabolic alkalosis?
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An increase in bicarbonate
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What is the respiratory compensation for metabolic alkalosis?
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Hypoventilation to increase pCO2
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Why does ASA increase the risk of gastric irritation and bleeding?
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It inhibits the synthesis of prostaglandins which are responsible for the protection of the gastric mucosa
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Why does ETOH increase the risk of gastric irritation and bleeding?
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It disrupts the permeability of the gastric mucosa and allows the influx of H+ ions
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What occurs during sympathetic stimulation of the GI tract?
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Decreased secretions, decreased motility, enhanced sphincter control, and increased smooth muscle tone
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What occurs during parasympathetic stimulation of the GI tract?
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Increased secretions, increased motility, decreased sphincter control, and decreased smooth muscle tone
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What supplies the parasympathetic innervation of the GI tract?
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Vagus nerve
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What are the early signs of colon cancer?
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Bleeding is the most frequent sign followed by changes in bowel habits, constipation or diarrhea, a sense of urgency. Pain is a late symptom
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What are the major effects of bowel obstruction?
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An alteration in fluid and electrolytes and abdominal distention which can lead to strangulation of the bowel, gangrenous changes, perforation, and sepsis
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What do Kupffer's cells do?
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These are liver cells that destroy old/damaged RBC's, foreign materials, bacteria.
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What are the 4 major causes of jaundice?
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Excessive destruction of RBC's, impaired uptake of bilirubin by the liver cells, impaired conjugation of bilirubin, and obstruction to bile outflow
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What does edema represent?
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An imbalance between the capillary/interstitial forces
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What are the sources of serum bicarbonate?
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Carbon dioxide, increased reabsorption of bicarbonate, and increased renal production of bicarbonate
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How does vomiting cause metabolic alkalosis?
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The excessive removal of H+ ions contributes to the alkalosis, but the stimulated production of bicarbonate by vomiting maintains the alkalosis
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What is the main function of parathyroid hormone?
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To maintain the ECF concentration of calcium
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What are the manifestations of hypocalcemia?
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A serum level of calcium less than 8.5, tetany, hyperreflexia, spasms, cramping, bone pain, bone deformities, and fractures. Also, parasthesias, hypotension, and cardiac insufficiency
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What forms does calcium exist in?
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Ionized, protein bound, and complexed
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What are manifestations of hypercalcemia?
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A serum calcium greater than 10.5, muscle weakness, polyuria, polydipsia, kidney stones
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Where is 98% of the body potassium?
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In the intracellular fluid (ICF)
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What two endogenous materials cause uptake of potassium into the ICF?
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Insulin and beta-adrenergic catecholamines
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Why does potassium increase with metabolic acidosis?
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As H+ ions enter the ICF, they push potassium ions out
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What happens to parathyroid hormone when calcium increases?
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It is inhibited
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What is the main function of sodium?
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To maintain fluid/volume regulation and maintenance of nervous system and other excitable tissues
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How does sodium normally enter the body?
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Through the GI tract
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Where is most of the body's sodium?
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In the extracellular fluid (ECF)
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What mechanisms are responsible for HTN in CRF?
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The renin-angiotensin system, aldosterone, increased volume, increased pvr, decreased renal vasodilator prostaglandins
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What is renin and where is it stored?
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Renin is an enzyme that is synthesized and stored in the juxtoglomerular cells of the kidney
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When is renin released?
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During periods of low blood flow, fluid composition changes, or SNS
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What does renin do?
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It converts angiotensinogen to angiotensin I
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What does angiotensin I do and where does this process occur?
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It is a weak vasoconstrictor that is converted to angiotensin II by ACE in the lungs
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What is angiotensin II's function on the kidneys?
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It acts as a direct vasoconstrictor on the kidney
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What effect does angiotensin II have on aldosterone?
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It stimulates it's release from the adrenal gland
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What does aldosterone do?
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It increases sodium and H2O reabsorption within the distal tubule
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When is ADH (vasopressin) released?
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When blood volume decreases, BP decreases, osmolality of body fluids increases
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What effect does ADH have on urine?
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It reabsorbs H2O from the urine and increases urine osmolality
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What is the most common cause of acute pancreatitis?
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Gallstones and alcohol abuse
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What is the most common initial symptom of acute pancreatitis?
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Severe epigastric and abdominal pain that radiates to the back
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What hemodynamic disturbances are associated with acute pancreatitis?
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A large volume shift of fluid into the retroperitoneal and peripancreatic space within the abdomen, hypotension, tachycardia, cool/clammy skin
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What are the major complications of portal HTN?
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Ascites, splenomegaly, and the formation of portosystemic shunts
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What is acute pancreatitis?
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A life-threatening disorder associated with the escape of activated pancreatic enzymes into the pancreas and surrounding tissues leading to fat necrosis, fatty deposits into the abdominal cavity and hemorrhage
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What test is used to diagnose acute pancreatitis?
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Total serum amylase
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What replaces functional liver tissue in cirrhosis?
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Fibrous tissue
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What is an early sign of hepatic encephalopathy?
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Asterixis-a flapping tremor
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What is the first step in the treatment of ARF?
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Identifying and treating the cause, fluid regulation, adequate caloric intake, and dialysis or CRRT
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What are the common characteristics of ATN?
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Azotemia, HTN, edema, hyperkalemia, a decrease in GFR
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How does one assess the kidney's ability to concentrate urine?
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Urine osmolality, urine sodium concentration, and fractional exertion of sodium
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What inflammatory process is the leading cause of CRF in the US?
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Glomerulonephritis
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What characterizes glomerulonephritis?
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Hematuria with RBC casts, azotemia, decrease GFR, oliguria, and HTN
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What infection causes acute proliferative glomerulonephritis?
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Group A beta-hemolytic streptococci
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What is the functional unit of the kidney?
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Nephron
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What are the cardinal signs of SIADH?
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Hyponatremia, naturesis, adequate renal/adrenal function, no edema, increased urine osmolality, decreased serum osmolality
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What is the treatment for SIADH?
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Fluid restriction, diuretics, lithium, and demeclocycline
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What regulates the reabsorption of water by the kidney?
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ADH
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How much erythropoetin is formed in the kidneys?
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89-95%
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What stimulates the synthesis of erythropoetin?
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Tissue hypoxia
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Why are persons with CRF prone to anemia?
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The kidneys are responsible for the production of erythropoetin
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How is anemia in CRF managed?
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Epogen
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What are the characteristics of fluid volume deficit?
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Decreased ECF/circulating volume, weight loss, thirst, decreased turgor, and impaired temp. regulation
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What are the characteristics of fluid volume excess?
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Rapid weight gain, edema, pleural effusion, ascites, increased CVP, and distended neck veins
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What happens to ADH in SIADH?
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It is secreted despite an decrease in serum osmolality
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What happens to calcium with alkalosis?
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Hypocalcemia
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What happens to fluid and electrolytes in burns with 3rd spacing?
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Fluid leaves the vascular/interstitial space, sodium is lost from ECF, potassium is lost from ICF
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What is psychogenic polydipsia?
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A compulsive obsession of water drinking usually seen in psychiatric disorders like schizophrenia
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