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237 Cards in this Set
- Front
- Back
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blood- % of body weight + type of tissue |
7-8% connective tissue
formed elements- 45% (RBC, WBC platelets)
plasma ECF- 55% (water 92% + proteins & other substances 8%) |
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components of blood |
plasma- straw-colored fluid w/ dissolved solutes + clotting factors (fibrinogen)
serum- same as plasma but w/o clotting factors
formed elements |
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functions of blood |
transportation regulation protection |
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transportation- function of blood |
respiration- mobilization of gases
nutrition- absorbed nutrients delivered to body
excretion- wastes sent to liver/kidneys to be removed |
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regulation- function of blood |
hormones- mechanis depend on blood to deliver hormones to target organ
thermoregulation- cool or warm the body by diversion of blood |
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protection- function of blood |
hemostatis- protect against blood loss during damaged vessels (positive feedback)
immunity- WBC, cytokines + proteins act as pathogens against dz |
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hematopoiesis |
process by which all blood cells form from precursor mother cells
1st by yolk sac 2nd by liver 3rd by bone marrow |
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blood plasma + proteins |
92% water + proteins is 7-9%
albumin globulin fibrinogen |
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albumin |
smallest in size, 60-80% of total plasma proteins
function: draws fluid from tissues to capillaries.
colloid osmotic pressure to maintain blood volume + pressure
carrier for substances -transport in plasma |
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globulin |
alpha & beta- transport lipids, fat soluble vitamins
gamma- increase immune response to viruses |
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finbrinogen |
clotting factor. largest protein 4%. forms fibrin threads for bloog coagulation for hemostasis -lack nuclei + mitochondria |
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erythrocytes (RBC) |
formed element most numerous of formed elements flattened biconcave disc good for gas diffusion on surface area
120-day life span -280 mil hemoglobin- able to bind to 4 oxygen molecules
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RBC Hematocrit percentage guys + girls |
guys- 42-52% females- 37-47% |
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Leukocytes (WBC) -formed from myeloblasts |
-buffy coat -contain nuclei, mitochondria + organelles -move in amoeboid fashion, squeeze thru pores in cap walles via diapedesis /extravasation -classified- staining properties
granulocytes -basophils, eosinophils, neutrophils agranulcytes -lymphocytes and monocytes |
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Neutrophils |
multilobed nucleated -most abundant 60-70% of WBC -amoeboid motility + phagocytic activity -anti-bacterial functions -many small neutrophilic granules give sandy appearance |
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eosinophils |
1-4% of WBC bilobed nucleus -no phagocytosis -allergenic + anti-parasitic activities, mediates inflammatory response -contain eusinophilic granules- histaminase, peroxidase, collagenase |
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Basophils |
least numerous 0-.5% of WBC lobulated 2-3 lobes -no phagocytosis -hypersensitivy, anaphylaxis (IgE), allergies -basophilic granules contain heparin, histamine, leukotrienes |
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Lymphocytes |
25-30% WBC round nucleus no phagocytosis, little cytoplasm no specific granules (but have lysosomes) -immune response against pathogens, foreign substances + cancer cells |
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monocytes |
3-8% kidney-shaped nucleus migrate into tissues + constintue mononuclear phagocytic system no specific granules, but have lysosomes -inflammatory response -antigen presenting cells |
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platelets (thrombocytes) |
smallest formed element in buffy coat lack nuclei derived from megakaryocytes in bone marrow by thrombopoiesis are cell fragments of megakaryocytes amoeboid movement + aggregation function: hemostasis 5-10 day life |
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Gregor Johann Mendel |
genetic principle- A + B antigens are inherited traits that determine our specific genotype |
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Karl Landsteiner |
ABO blood typing system |
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antigens |
found on surface of cells to help immune system recognize self cells (identity marker receptors) |
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antibodies |
secreted by lymphocytes in response to foreign cells/antigens |
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ABO system |
based on antigen markers on erythrocyte cell surface
clusters show + for that blood type |
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A blood type |
A antigen anti-B antibodies Can receive from A + O can donate to A. AB |
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B blood type |
B antigen Anti-A antibodies Can receive from B, O Can donate to B, AB |
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AB blood type |
AB+ is universal recipient least common A antigen + B antigen No antibodies can receive from A, B, AB, O can donate to AB |
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O blood type |
O- is universal donor most common no antigen both anti-A + anti-B antibodies can receive from O Can donate to A, B, AB, O |
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Rh blood type |
Rh antigen termed D, Rho(D) or D antigen presence of antigen + absence of antigen-
Rh neg ppl do NOT produce antibodies unless exposed to Rh antigen
Homozygous genotype (RR) Heterozygous genotype (Rr) homozygous recessive (rr)- Rh neg |
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hemostatis |
blood clots form on walls (hemostatic plug) of injured blood vessel. thwarts excessive blood loss + maintains blood colloidal -need balance b/w blood coagulation + anti-coagulating agents |
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hemostasis 3 stages |
vascular spasm chemotaxis platelet aggregation platelet plug formation
1) break/tear occurs in blood v wall (+ feedback starts) 2) platelets adhere to site + release chemicals 3) released chemicals attract more platelets 4) platelet plug forms (feedback cycle ends when plug forms) |
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steps in blood clotting mechanism -extrinsic |
activator- tissue factor IIII w/ calcium, clotting factr VII Factor VII- tissue factor complex activated factor X (prothrombinase) prothrombin- thrombin fibrinogen with thrombin (common pathway) fibrin from fibrinogen w/ clottin factor XIII makes fibrin polymer
damaged tissues release chemicals that iniate clotting (shortcut) |
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blood clotting mechanism- intrinsic |
activators- collagen, glass, others with calcium clotting factor XII activated factor XII with clotting factor XI Activated factor XI with clotting factor IX- clotting factor IX Factor VIII-activated factor IX complex factor X with factor VII and factor VIII activated factor X (prothrombinase) prothrombinase factor X w/ prothrombin thrombin. with fibrinogen (common pathway)-fibrin fibrin w/ clotting factor XIII make fibrin polymer
blood left in test tube will clot on own w/o addition of external chemicals |
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finbrinolytic mechanism |
platetels in process of clot retraction + destruction plasim formed from plasminogen from tissue plasminogen activator- made by uPA (Urokinase-type plasminogen activator)
fibrinolysis- activates lambda granule released- deactivation of clotting factors IX, X, XI, XII and clot destroyed |
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anemias |
low RBC count in hematocrit or decreased hemoglobin |
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sickle cell anemia |
genetic, mutation of B-globulin of hemoglobin A- nml is A. In SCA, hemoglobin S + hemoglobin C found. rigid and tense RBC shaped like 'sickle' or boat |
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polycythemia |
too many RBC in hematocrit higher than 18.5. 52 and up in men, 48 and up in women
blood-doping (induced polycythemia for athletes- more oxygenation + nutrition to body) -direct blood transfusions -EPO analog injections
can naturally do it to help training (live in high altitude, hypoxia [reduced body oxygenation] force bone marrow to make more RBC) |
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Erythroblastosis fetalis |
Rh- preg mother w/ Rh+ fetus -small amount of fetal RBC enter mother's bloodstream. trigger immune response to produce anti-Rh antibodies -dangerous to SECOND pregnancy because mother has already been introduced to opposite Rh. so she has developed anti-Rh antibodies
Rhogam serum- anti-Rh antibodies- prevent Rh- mother from producing antibodies |
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transfusion complications |
blood does not match up. causes hemolysis of RBC. side effects- jaundice from bilirubin (from RBC death) -renal failure + death |
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Which of following are located in buffy coat? |
neutrophils lymphocytes platelets |
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pt who has type A+ blood can receive from whic blood types during transfusion? |
A+, O+ |
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primary function of lymphocytes is to |
act against foreign substances |
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female pt has blood test. 1 mL of her blood drawn, spun in centrifuge, and plasma volume measured = .6 mL. 2 mnths later, pt returns, after another blood test, dr tells pt she has become anemic compared to last visit. Which of following most likely woman's hematocrit on 2nd visit? |
35% nml for women is about 37-47% |
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main functions of blood include: |
-transport of 02 + CO2 -thermoregulation of body temp -transport of hormones to target tissues -protect against foreign pathogens introduced into body |
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____ maintain osmotic pressure needed to draw h20 from surrounding tissues to capillaries |
albumin |
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which of following women are most at rist for erythroblastosis fetalis? |
an O- mom who gave birth last yr to B+ baby and is now pregnant with A+ baby |
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Which of following is considered the universal recipient? |
Type AB+ |
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Which of following statements correct about erythrocytes? (all that apply) |
-are biconcave shape -erythrocytes lack nuclei |
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if your mother is Type AB- and your father is Type O+ you CANNOT be___ (all that apply) |
Type B- Type AB- Type O- |
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Which of 2 pt's produced antibodies against antigen A? |
Pt B- No clusters formed on anti-A |
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Pt A is able to accept transfusion from which following blood type donors (all that apply) |
Pt A cluster- Anti-A and Anti-D
Type A and Type O |
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Antibodies against Rh factor are only produced after an Rh- person is exposed to Rh+ blood
T or F |
True |
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The term agglutination is used in reference to platelet aggregation during blood clotting |
false
agglutination term used to describe RBC aggregation as result of antibodies binding + reactions |
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Erythrocytes are cell fragments derived from megakaryocytes in bone marrow |
false
Platelets are cell fragments from megakaryocytes in bone marrow |
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avg life span of WBC is approx 4 months (120 days)?
T or F |
False- RBC live for 120 days |
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all of following statements about blood platelets are true except |
they are 2nd most numerous formed element in the blood
true is: -they have canalicular system that is cont w/ cell membrane -they are not considered blood cells -they have central bundle of microtubules that function in elaboration of filopodia -cause blood clot retraction by interaction of actin, myosin and ATP |
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Which of following BEST describes erythrocytes? |
when suspended in hypertonic solution, they will shrink and become crenated |
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which of following molecules of RBC membrane is responsible for determination of blood type? |
glycoproteins |
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which of following terms refers to % of packed RBC per unit volume of blood? |
hematocrit |
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shear effect |
pt with optimal nutritional practices and vigorious continous workouts have RBC that have shorter lifespan- leads to oxidative stress on RBC due to higher demand of oxygen supply |
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woman has A+ but newly born baby girl is B+
mother's genotype AA or AO? |
AO |
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woman has A+ but newly born baby girl is B+
What are all possible genotypes of father? select all that apply
AA AO BB BO AB |
BB BO AB |
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external respiration |
takes place at tissue level where gases are exchanged with the atmosphere |
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internal respiration |
gas exchange takes place at cellular level within mitochondria, where oxygen is used to generate energy in form of ATP |
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Functions of Respiratory System |
MAIN function: exchange oxygen and carbon dioxide. active exchange mechanism w/ lungs + external environ
-Contribution toward regulation of blood pH via acid-base substance balance. -activation of bioactive substances aas they circulate thru lungs (angiotensinogen via angiotensin converting enzyme ACE) -immunologic via inhabitant macrophages (dust cells) and other immune cells -water and heat dissipation (evaporation -facilitation of venous return via mechanisms of respiratory pumps -vocalization via parhyngeal apparatus and laryngeal cartilages |
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Lungs are the largest... |
structures of respiratory system and thorax |
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# of lobes
Right lung- Left lung- |
Right has 3 lobes (Superior, middle and inferior) Left has 2 lobes (superior and inferior) |
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Pleura |
serous membrane that surrounds lungs |
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Parietal pleura |
outermost membrane of pleura surrounding lungs. sensitive to touch, pressure and pain (afferent fibers by intercostal T1-T11) + phrenic nerves |
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Visceral pleura |
innermost membrane of pleura surrounding lungs. NOT sensitive to touch and pain but IS sensitive to stretch (by pulmonary nerves plexus) |
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Conducting passage (parts and role) |
nasal cavities, pharynx, larynx, trachea, bronchi and bronchioles.
functions in transporting gases into lung tissues |
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Respiratory passage (parts and role) |
respiratory bronchioles, alveolar ducts, alveolar sacs and microscopic alveoli in lung tissues
functions in allowing gas diffusion across BAB- formed b/w alveolar cells and capillaries. |
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trachea |
principle conducting pathway. cartilage and connective tissue. respiratory epithelium, pseudostratified columnar epithelial cells, goblet cells, cilia and microvilli.
basal cells- allow renewal of tracheal epithelium |
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ANS control of respiratory system |
beta 2 sympathetic adrenergic relaxes smooth M of bronchi (adrenalin + albuterol/isoproterenol)
cholinergic parasympathetic muscarinic- contract and air passage constriction |
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# of alveiol each lung has |
approx 300 million. surface mucosa reduced. simple squamous epithelium |
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Type I alveolar cells |
Pneumocytes type I 40% of alveolar mucosa cells, most of walls of alveolar surface. |
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Type II alveolar cells |
Pneumocytes Type II, septal cells 60% of alveolar mucosa cells, only cover 3-5% of alveolar surface.
have surfactant (dipalmitoylphosphatidylcholine [DPPC] which reduces surface tension of alveoli and prevents alveoli from collapsing from pressure of expirations |
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Dust cells |
macrophages in lungs. remove pollutants inhaled from air spaces and RBC from septal area. dust cells can phagocytose M. tuberculosis.
brush cells- may act as receptors monitoring quality of air cruising alveoli septum |
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zone 1 pressures in lungs (apex) |
alveolar pressure > arterial pressure > pulmonary venous pressure |
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zone 2 pressures in lungs |
arterial pressure > alveolar pressure > pulmonary venous pressure |
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zone 3 pressures in lungs (base) |
arterial pressure > pulmonary venous pressure > alveolar pressure |
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Thromboxane A |
vasoconstrictor produced in response to pulmonary injuries |
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Prostacyclin I |
vasodilator produced by endothelial cells |
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NO (nitric oxide) |
produced by endothelial cells in pulmonary blood vessels- vasodilation |
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inspiration |
active phase.
Intrathoracic volume inc intrathoracic pressure dec
diaphgram contracts & lowers gut viscera
external intercostal M expand intercostal spaces + elevate ribs
sternocleidomastoid + scalene M elevate + fix upper ribs |
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expiration |
passive process
inverted pressure forces b/w atmosphere + lungs
diaphragm + abdominal viscera are pushed up
internal intercostals decrease intercostal spaces
anterolateral abdominal M -rectus abdominis, external and internal obliques- engaged |
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Anatomic dead space |
volume of conducting portion of respiratory system airways (pharynx, trachea, bronchi + bronchioles)
nml - 150 mL |
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physiologic dead space |
total volume in lungs not involved in gas exchage- includes volume of anatomic ds + functional dead space in alveoli, usually = amount as anatomic ds
if it isn't shows ventilation/perfusion deficiencies
Vd = Vt (Pac02-PEc02/Pac02) |
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Ventilation |
volume of air moved in and out of lungs in unit of time
minute and alveolar ventilation |
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perfusion |
process of blood passing thru pulmonary circulation to be oxygenated |
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tidal volume (Vt) |
volume of air inhaled in 1 breath during nml breathing- nml 500 mL |
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functional residual volume (FRC) |
nml volume of air remaining in lungs after nml quiet expiration
after breathing out nmly, how much is left in lungs nml- 2400 mL FRC = RV+ERV |
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expiratory reserve volume (ERV) |
max volume of air person can exhale without maximal effort after nml quiet expiration
nml is 1200 mL
blowing out as much air as possible after nml exhale |
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residual volume (RV) |
amount of air remaining in lungs after max expiration-
maintains inflation of alveoli b/w breaths = 1200 mL
can't breathe this air out |
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insiratory reserve volume (IRV) |
max volume of air person can inhale after nml quiet inspiration nml- 3000 mL
taking breath, then breathing in even more |
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inspiratory capacity (IC) |
Highest amount of air volume that can be inhaled after exhalation during nml quiet breathing. - 3500 mL IC = IRV + VT
breathing in really deep after breathing out nml |
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total lung capacity (TLC) |
max volume of air lungs can hold nml - 6000 mL RV + VC
total amount air possible for lungs to hold |
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vital capacity (VC) |
max volume of gases person can exhale following maximal inspriation |
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forced vital capacity (FVC) |
Vital capacity when taken during exhalation at max force nml 4700-5000 mL |
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rest stage |
diaphragm is balanced no air flow moving in or out
alveolar pressure = atmosphere pressure (both 0)
P IPL (intrapleural pressure) is -5 cm H20 Transmural pressure is +5 cm H20 |
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Insiration stage |
diaphragm is contracted air flowing in lungs
alveolar pressure is -1 cm h20 atmospheric pressure is 0
intraplural pressure P ipl is -6.5 transmural p is +5.5 |
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expiration stage |
air flows out of lung
alveolar pressure is +1 atmospheric pressure is 0
P ipl iis -6.5 transmural p is +7.7 |
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at rest- content of o2 |
250 mL Ficke's law diffusion- diffusion of gases across cap membrane |
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dissolved 02 in blood |
.3 mL in blood
hemoglobin (Hb)- transports 02 blood - makes avg 02 around 20.4 mL |
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02 binding capacity |
max amount of 02 that can be bound to Hb per value of blood |
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total 02 content |
02 binding capacity x %saturated Hb + Dissolved 02
% saturated Hb is dependent on 02 partial pressure - P02. when P02 is 25, Hb sat % is 50
oxyhemoglobin dissociation curve- sigmoidal shaped graph |
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variables altering oxyhemoglobin diss curv |
Temp Pc02 (pressure of c02) pH (c02 makes blood go down in pH, more acidic) |
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3 forms c02 transported in blood |
-bound to Hb- main form -dissolved c02 (h20 + co2 --> h2co3) -as hco3 (h2co2 --> hco3- + H |
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Haldene effect |
linear graph left side shift c02 dissocation curve |
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neural control of resp - pons |
ANS and CNS apneustic center pneumotaxic center
both exert mutual inhbition of each other |
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apneustic center of pons |
regulates inspiration thru phrenic nerve relaying contraction of diaphragm |
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pneumotaxic center of pons |
controls depth + rate of respiration. also turns off inspiration (swimming underwater) -cerebral cortex gives it afferents |
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neural control of resp in medulla |
ventral resp nucleus VRN dorsal resp nucleus DRN peripheral chemoreceptors central chemoreceptors |
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ventral respiratory nucleus (VRN) of medulla |
VRN innervates exhalation M |
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Dorsal respiratory nucleus (DRN) of medulla |
DRN innervates inhalation M |
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peripheral chemoreceptors of medulla |
aortic and carotid bodies respond to pH, Pa 02 + Pa c02 changes |
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central chemoreceptors of medulla |
located in ventral lateral medulla + respond to Pa 02 and Pa c02 changes
ex- Pa c02 drops, CSF pH elevates, deceleration of respiration |
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effects of moderate exercise on respiration |
no changes: -arterial P o2 and P co2
increased: -respiratory rate -02 intake -co2 production -cardiac output -pulmonary circulation -oxyhemoglobin dissociation curve
decreased: physiologic dead space |
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acid base resp disorder |
resp abnormalities- pH changes resp alkalosis resp acidosis |
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respiratory alkalosis (acid base resp dz) |
elevated blood pH due to decreased c02 hyperventilation (panic attack) |
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respiratory acidosis (acid base resp dz) |
decreased pH due to hypoventilation and increased c02- pul obstructive dz |
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nml pulmonary levels |
FEV- 3 L FVC - 4 L FEV/FVC - 75% |
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restrictive pulmonary dz |
labored inhalation dec lung volume functionality dec lung compliance low TLC and low FRC interstitial lung dz (idiopathic pul fibrosis and asbestrosis)
FEV- 2.5 L dec FVC- 3 L dec FEV/FVC- 83% inc |
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obstructive pulmonary dz |
labored air exhalation from lungs low pulmonary flow rate and low gas exchange inc lung compliance + dec elasticity high TLC + high FRC asthma, COPD, cystic fibrosis, bronchiectasis
FEV- 1L dec FVC- 4L same FEV/FVC- 25% dec |
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COPD |
OBSTRUCTIVE DZ abuse of cig smoking mucus buildup productive cough- bronchitis dyspnea + wheezing, dec + enlarged alveolar walls (emphysema) hypoxia + hypercapnia hypoxic resp drive tx: cessation of smoking, albuterol, abx, steroids |
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asthma |
OBSTRUCTIVE DZ bronchial wall-broncho-constriction,hypersecretion swelling (edema)
-extrinsic- allergen (atopic) and intrinsic- substances trigger it
3 worst symp (resp airway edema, bronchoconstriction + mucus buildup)
-exaggerated inflammatory response via mast cells, basophils + neutrophils. abundant clara cells (mucus buildup) tx: anti-infl steroids (corticosterone), Cl blockers, bronchidilators (albuterol) but also inc HR |
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Respiratory distress syndrom |
neonatal resp dis syndrome (NRDS)- lack of surfactant and DPPC
-maternal DM, premature, C-section birth, perinatal aspyhxia
tx: prophylactic admin of exogenous surfactant, 02 therapy vent support, nasal cont + airway pressure (NCPAP) machine |
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pathway of respiratory system from conducting to resp |
larynx- trachea- primary brochi- secondary bronchi- tertiary bronchi- smaller bronchi- bronchioles- terminal bronchioles- resp bronchioles- alveolar sacs |
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steps in respiratorion (4 steps) |
1- ventilation 2- gas exchange- 02 and c02 b/w lungs + blood 3- blood transport of 02 + c02 to + from lungs + tissues 4- 02 and co2 exchanged b/w blood and systemic tissues |
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boyle's law |
pressure of gas inversely proportional to volume |
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hypoxic vasoconstriction |
nml pt, vasoconstriction of pulmon arteries occur in response to low oxygen concentration in underventilated alveoli
can lead to pumonary hypertension |
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during unforced exhalation/expiration, which of following would not be true? |
intrapleural pressure > alveolar pressure
true: alveolar pressure > atmospheric pressure -intrapleural p becomes less - -diaphragm relaxes -lung volume decreases |
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volume of air flowing in alveoli during inhalation/inspiration is inc when there is an inc in |
pressure gradient from atmosphere to alveoli |
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under nml circumstances, at rest the intrapleural pressure is approx: |
-5 cm h20 |
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regarding the response of arteriolar smooth M to changing oxygen partial pressure, which of following is true? |
systemic arterioles respond to dec in Po2 by dilating but pulmonary arterioles constrict in response to decreased Po2 |
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which of these may be a consequence of hyperventilation? |
decreased alveolar Pc02 and incr alveolar Po2 |
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which of following may be a result of hyperventilation? |
respiratory alkalosis incr pH and dec c02 |
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which of these would tend to increase ventilation? |
c02 production |
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leslie a 25 yr old prego mom in 25th week pregnancy- gave birth to premature baby 2lb2oz- baby cried after 1st breath, showed signs of hypoventilation, hypoxia. mother was fine and stable. which of following is MOST imperative for baby's survival? |
endotracheal intubation and surfactant inhaler (endotracheal) |
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which of following equations would be used to calculate physiologic dead space? |
VD= Vt (Pac02-PEc02/Pac02) |
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manual, 65 yr old male goes to ED with SOB and hypoventilation. hx of chronic tob abuse over 30 yrs. dx with emphysema- still smokes. which of following spirometry curves is accurate? |
C- Obstructive dz with FEV- 1 L, FVC- 4 L (same) and FEV/FVC - 25%
red curve- longest |
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within medulla, 2 regions VRN and DRN exert distinct resp control. VRN composed of neurons corresponding to which of following structures? |
retroambiguus, retrofacialis, ambiguus nuclei |
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which of these does NOT increase during vigorous exercise? |
Arterial Pco2 |
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factors changing lung volumes + capacities? |
age weight and ethnicity as well as gender |
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distal to prox pathway of resp pathway toward BAB 10- most distal. 1 -most prox |
10-trachea (conducting) 9- carina (conducting) 8- primary bronchi (conducting) 7- secondary bronchi (conducting) 6- tertiary bronchi (conducting) 5- terminal bronchiole (conducting) 4- respiratory bronchiole (resp) 3- alveolar ducts (resp) 2- alveolar sacs (resp) 1- alveolus (resp) |
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Urinary system |
composed of kidneys, ureters, urinary bladder and urethra |
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kidneys |
left kidney superior border lies at T12 right kidney base border lies at L3 (right kidney is largest)
main function is to filtrate
stroma- innermost surrounding is myofibroblasts- support and resist volume + pressure changes
parechyma- cortex- outermost portion medulla- innermost portion |
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functions of kidneys |
filtrate -regulation of volume comp and pH of body fluids -regulation of plasma osmolarity via aquaporin receptors -regulation of energy metabolism via gluconeogensis (fasting + starvation) -detoxification of metabolic wastes thru excretory mechanisms -secretion of erythropoietin (EPO)- hormone that stimulates RBC production in bone marrow -secretin of renin- enzyme that regulates blood pressure- converts engiotensiongen to angiotensin I -conversion of Vit D3 to active form 1,25 dihydroxyvitamin D) |
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functional unit of kidney responsible for urine formation |
nephron
located in renal pyramid
proximal tubule loops of henle (desc and ascending) distal tubule collecting ducts |
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Renal Corpuscle |
glomerulus + Bowman's capsule
juxtaglomerular apparatus- where DCT returns to originating corpuscle at vascular pole |
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juxtamedullary nephron |
least common (15-20%) longer loops of henle. glomeruli in inner (deeper) part of cortex- more concentrated urine
dessert animals would have this- not as much cortical |
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cortical nephron |
most common (80-85%) shorter loops of henle glomeruli originate in outer region of cortex |
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albuminuria |
pathological condition of BM (basement membrane of glomerula)- larger amounts of proteins pass thru BM |
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vasoconstriction factors |
angiotensin II, endothelin, epinephrine, norepinephrine, sympathetic innervation
decrease RBF (renal blood flow) and GFR (glomerular filtration rate) |
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vasodilation factors |
dopamine, prostaglandins (PGI + PGE), bradykinin and NO
protective effect on kidneys against systemic hemorrhage protect RBF |
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movement of blood in kidney |
renal artery- segmental aterty- interlobular artery- arcuate artery- interlobular artery- afferent arteriole- glomerulus (filtration)- efferent arteriole- peritubular cap- vasa recta- interlobular vein- arcuate vein- interlobular vein- segmental vein- renal vein |
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movement of filtrate/urine |
glomerulus- filtered to glomerular capsule- PCT- Loop of henle- DCT- collecting duct- minor calyx- major calyx- renal pelvis- ureter- urinary bladder- urethra |
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vasa recta |
specialized vascular arrangements of peritubular cap of juxtamedullary nephrons
thin and elongated blood v- countercurrent exchange system- osmotic mechanism responsible for production of urine concentrated products |
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glomerular filtration |
initial stage for urine formation regulated by RBC thru caps of glomerulus- fluids filtered thru cap membrane are ultrafiltrate
GFR- glomerular filtration rate- indicator of renal function
males- 125 mL / min females - 115 mL/min |
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Starling's equation |
GFR= Kf ([Pgc-Pbs) - P(pi)gc)] kf- coeff of filtration Pgc- glom cap hydrostatis pressure Pbs- bow cap hydrostatis presure PpiGC- glom cap oncotic pressure
principles (4) 1) cap blood hydrostatic pressure (fluids out) 2) interstitial fluid hydrostatic pressure 3) cap blood oncotic pressure 4) interstitial fluid oncotic pressure (fluids in) |
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renal clearance |
volume of plasma cleared of any substance in min
inulin- clearance is potential indicator of GFR |
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renal filtration |
volume of substances filtered into urinary space
filtered load-represents this amount ^ |
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reabsorption |
mostly involve membrane proteins acting as transporters that bring water, hco3, Na and Cl, amino acids, Mg and others into bloodstream
or else would be massively lost in urine |
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secretion |
mechanism by which certain organic substances such as some organic acids and bases are excreted in urine |
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excretion rate |
addition of all mechanisms of filtration, reabsorption and secretion |
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PCT |
proximal convulated tubule
venue of glomerular homeostasis 3 segments- s1 (early) S2 ad S3 (which are late)
//67% of h20 and Na reabsorbed here- isomotic reabsorption //100% glucose and amino acids reabsorbed here k, phosphatePO4 HCO3 reabsorbed
contransport of glucose and Na secondary active transport membrane receptors GLUT 1, GLUT 2 renal threshold for glucose transport is 200 mg/dL |
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glycosuria |
glucose is abnormally excreted in urine
if plasma glucose concentrations increase above nml parameters (above 350)
DM pt, congenital abnml like fanconi syndrome, pregnancy as well |
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loop of henle |
passive reabsorption of water active reabsorption of salt (NaCl) thick ascending limb regulated by ADH site of action for Loop diuretics (furosemide)
thin descending- allows water, sodium chloride and urea in- hyperosmotic
thin ascending- sodium chloride but NOT water- hyposmotic
thick ascending- sodium via transport, Ca and Mg. NOT PERMEABLE TO WATER (dilution of urine) -^^ Known as diluting part of loop of henle |
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early DCT |
early distal convulated tubule
reabsorbs 5% filtered na and Ca IMPERMEABLE TO WATER (no aquaporins) called cortical diluting segment site of action for thiazide diuretics PTH stimulates Ca reabsorption |
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l DCT and CD |
Late distal convulated tubule and collecting duct -Na reabsorp important for homeostasis
Principal- light cells - rich in aquaporins, regulated by ADH for water reabsorption- more plasma volume + less urine volume -Na reabsorp and K secretion regulated by Aldosterone -----hormone leading to Na+water retention, K loss site of action for K sparing diuretics- Spironolactone
Alpha + Beta (dark cells) intercalated cells -maintain pH of urine -H+, HCO3, NH4 secretion |
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diffusion trapping |
NH3 lipid soluble, but not NH4
if urine pH dec, secretion of NH4 increased |
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Aquaporins |
AQPS
transmembrane receptors that selectively transport water 13 types in humans AQP1- in PCT descending loop and vasa recta AQP2 3 and 4- principal cells of CD AQP8- inner mitochondrial membrane |
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pth
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Parathyroid hormone -inhibits Na PO4 transport in ePCT lower plasma PO4
stimulates Ca in eDCT elevates plasma Ca |
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Angiotensin II |
stimulates Na H exchange in ePCT Na and water retention elevates plasma volume |
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ADH |
vasopressin stimulates Na K Cl cotransport in thick asc loop of henle water retention in DCT and CD higher plasma volume |
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aldosterone |
Na and water retention with K loss in DCT and CD higher plasma volume and hypokalemia |
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avg urine volume a day |
avg urine volume in a day- 1.5 to 2 L min urine obligatory loss is .5 L bladder can distend to contain 400-600 mL
155 lb subject, obligatory volume of urine is approx 500 mL a day- provides for excretion of estimated volume of 600 mOsm of waste products a day |
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ANS control of urinary bladder |
parasympathetic contracts urinary bladder
internal sphincter- smooth M involuntary control
external sphincter- skeletal M voluntary
when urin bladder relaxed and filling both sphincters closed to prevent voiding of bladder contents |
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Exercise renal function and k homeostasis |
during exercise, RBF is reduced due to hgh symp activity Reduced RBC- low GFR- lower urine volume
during exercise, K is shifted out of cells- high K in blood- vasodilatory effects-inc blood flow to M
K and other electrolytes lost via sweating during exercising
inc K in plasma (blood) reabsorbed in late DCT+ CD
Meds like B blockers shift k out of cells --affect K homeostasis during exercise--hyperkalemia |
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Fanconi syndrome |
genetic or acquired
reduced absorption of amino acids, glucose, phosphate, urate, bicarbonate. abnml excretion of these which are nmly reabsorbed in renal tubules. mainly PCT
- changes in permeability of tubular membranes - alterations in cellular energy metabolism - dysfunction of carriers that transport substances across luminal membrane
can lead to -cystinosis (abnml cysteine amino acid accumulation in cells) -renal failure |
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renal failure |
inability of kidneys to perform their regulatory and excretory functions to meet homeostasis
acute- sharp rapid onset- reduced urine production oliguria- death
chronic- deliberate cont onset decreased renal function- permanent- kidneys can sustain function even with 75% of damage end-stage renal dz- 90% > damage
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ADH abnormalities |
1) Diabetes insipidus (low ADH secretion-activity) can lead to -central - head trauma or post surgery -nephrogenic- mutated ADH renal receptors
2) SIAD- inapprop ADH secretion can lead to -central- pituitary or brain metastasis -systemic- lung cancer |
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proteinuria |
presence of proteins in urine- abml increase in permeability of kidney glomeruli -renal infections renal failure |
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glycosuria |
glucose nmly reabsorbed from renal tubules into blood in PCT- carrier mediated nml being 70-110 mg/dL
renal plasma threshold- blood glucose level exceeds it, too many glucose for carriers, nontransported glucose remains in urine
caused by DM
nml in- -uncontrolled DM, fanconi syndrome, preg and congenital abnml |
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ketouria |
neg test result is nml. ketone bodies found in urine during carb deprivation-starvation or highprotein low carb diets.
in these cases^ body relies on metabolism of fats for energy DM pt's also have ketones in urine due to lack of insulin-body cannot metabolize carbs |
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hemoglobinuria |
neg test result is nml. -level of hemoglobin in blood rises too high, Hg appears in urine.
-hemolysis in systemic blood v (transfusions) -rupture of glomerular cap -urinary system hemorrhage (pyelo) -low osmotic pressure of urine cause hemolysis (+ releasing of hemoglobin from RBC) -PCH (cold climate antibodies attack RBC) -PNH (RBC missing PIG-A) nml in menstruating women |
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Hematuria |
RBC found in urine can happen due to hemoglobinuria |
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Bilirubinuria |
bilirubin (dead RBC) found in urine- not nml -test to dx liver or gallbladder problems -bilirubin yellowish color in bile- produced by liver. large amounts of bilirubin=jaundice
-biliary strictures -cirrhosis -gallstones in biliary tract -hep (biliary obstruction) -post-surgical trauma affecting bil tract -tumors of liver/gallbladder |
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nitrite |
certain pathogens in urine can reduce dietary nitrates into nitrite.- nitrite forms diazonium salt- reacts with chromogen to give color indicator in test -positive test shows bacteria present in high # in urine (gram neg E coli) - not good test if we have inc ADH (dilute urine) |
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specific gravity (SG) |
measures urine density + directly proportional to urine osmolarity- measures solute concentration.
-ability for kidneys to concentrate/dilute urine over that of plasma nml- 1.000 to 1.030
hyposmotic urine- SG < 1.008 hyperosmitic urine- SG > 1.020 higher number=more concentrated urine |
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urobilinogen |
small amount nml- formed from bilirubin by intestinal bacteria- nml- <17. most excreted in stool and small reabsorbed into circulation
big #'s of urobilinogen reacts w/ chromogen -forms azo dye, pink or purple color- best at room temp.
inc urobilinogen found= -liver tissue damage (viral hep, cirrhosis) -blood disorders (hemolytic anemia, excessive RBC breakdown) -poisoning + drug abuse |
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urine pH |
nml pH urine- 4.6 to 8 -used to measure risk of kidney stones -dtermining existence of systemic acid-base dz (metabolic or resp)
acidic urine -xanthine, cysteine, uric acid + calcium oxalated stones
alkaline (basic) urine -Ca carbonate, Ca phosphate, Mg phosphate stones -UTI - + leukocyte esterase (urea-splitting organism : Proteus- urea splits to c02 + ammonia---abnml inc in urine pH) |
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leukocyte esterase (LE) |
neg test nml- test for enzyme (leukocyte esterase) present in WBC -present in all granulocytes + catalyzes chromogens to produce color indicator nml is >4 RBC 96% UTI pt's have pyuria (pus in urine) > 10 WBC 75-90% tests are sensitive invalid tests -neutropenic (low neutrophil count pt) -pt w/ glycosuria -high urinary SG -antimicrobials in urine |
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renal lab results |
subject A- clear urine (glucose, bilirubin) subject B- light yellow (nitrite, no glucose) Subject C- Red yellow (RBC, protein) |
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Milky colored urine |
excess bacteria. fat content. mucus + epithelial cells |
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pale yellow urine |
pus (neutrophils),WBC-granulocytes |
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light yellow urine |
amorphous urate crystals |
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yellow urine |
vit and other supplements. meds |
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green-yellow (olive) urine |
colored food dyes. meds |
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red-yellow urine |
RBC, meds |
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Red urine |
RBCS foods (beets blackberies rhubarb) chronic lead/mercury poisoning meds |
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red-brown urine |
RBC, meds |
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Brown-black |
meds liver kidney disorders UTI foods - fava beans, rhubarb aloe in large amounts |
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grey-black |
drugs familial hypercalcemia -blue diaper syndrome |
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black |
drugs melanin residues |
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which condition pale yellow color...which test used? |
pus neutrophils- neg test result is nml
Uncontrolled DM + neutropenic pt not valid test |
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IVP |
Intravenous pyelogram- radiologic exam to assess renal function IN VIVO
ICM- iodinated contrast media inserted IV (intravenously) |
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sequence of blood flow in kidney |
renal artery segmental artery interlobular artery arcuate artery interlobular artery afferent arteriole glomerulus efferent arteriole peritubular cap vasa recta interlobular vein arcuate vein interlobar vein segmental vein renal vein |
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Main reabsorption for e PCT |
glucose, potassium, NaCl w/o water, amino acids, sodium phosphate |
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main reabsorption for late PCT |
potassium, NaCl w/o water, sodium phosphate |
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main reabsorption for thick asc loop of henle |
NaCl with water, calcium, magnesium |
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main reabsorption for early DCT |
NaCl with water |
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main reabsorption for late DCT |
potassium, NaCl w/o water, NaCl w/ water |
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main reabsorption for CD |
potassium, NaCl w/o water, NaCl w/ water |
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avg GFR values Male and Females |
Male GFR- 120 mL/min (173 L/day)
Female GFR- 95 mL/min (137 L/day) |
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pt with C h20 of -1.04 and plasma osmolarity of 230 when nml plasam osm is 300 |
ADH low or high? Significance of NEG free-water clearance? --ADH high- water reabsorbed in DCT + CD. --neg Free-water clearance=urine is more concentrated, hyperosmotic
Production of urine isomotic, hyposmotic or hyperosmotic? --hyperosmotic- water reabsorbed(in blood) taken from urine- urine is more concentrated (hyperosmotic = more concentrated urine)
how is excretion of water in pt? hydration status? --not excreting much water. pt dehydrated- reabsorbing all water in blood and not excreting enough in urine= needs more water |
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___ regulates Na reabsorption + K secretion in CD |
Aldosterone |
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Inadequate secretion of erythropoietin by kidneys will most likely result in _____ |
anemia (low RBC count) |
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_____ cells in juxtaglomerular apparatus secrete renin into afferent arteriole in response to a ____ in blood volume |
granular, decrease |
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countercurrent multiplication is established by the ____ |
loop of henle |
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what is main function of renal corpuscle (glomerulus + bowman's capsule)? |
production of ultrafiltrate that enters urinary tubules |
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purpose of microvilli in PCT is to _____ |
both C + D -aid in reabsorption -increase surface area |
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Phsyiologically, functional unit of kidneys is the ____ |
nephron |
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____produce higher concentrated urine due to their longer loops of henle |
juxtamedullary nephrons |
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in the collecting duct, h20 reabsorption occurs thru aquaporins, which are regulated by_____ |
ADH |
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Blood is delivered to glomerulus by the ____ |
afferent arteriole |
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______ catalyzes the conversion of angiotensinogen into angiotensin I |
renin |
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all of the following substances are present in Proximal tubular fluid in kidney, but which one is NOT normally present in urine? |
glucose
nml- Ca, H, K, HPO4- |
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antidiuretic hormone (ADH) promotes retention of water by stimulating _____ |
the permeability of CD to water |
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in this formula :GFR = K f [(Pgc - Pbs) - P(pi)gc]...what does P(pi)gc represent? |
glomerular capillary oncotic pressure |
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Countercurrent multiplication establishes a vertical hyperosmotic gradient across renal medulla
T or F |
True |
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Renal blood flow (RBF) is locally regulated specially by the efferent arteriole
T or F |
False
regulated by afferent arteriole |
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Inulin is potential physio indicator of glomerular filtration rate (GFR) of pt
T or F |
True |
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Glucose is transported into cell by Na- glucose luminal transporters SGLT, type of cotransportation receptors. 2Na and 1 glucose bind to cotransporter and glucose enter cell following/along its concentration gradient
T or F |
False
2 Na and 1 glucose bind to cotransporter and glucose enters cell AGAINST its concengration gradient |
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Glycosuria, polydipsia, and oliguria are all typical manifestations of DM and fanconi syndrome
T or F |
False DM and Fanconi = glycosuria, polydipsia and polyuria |
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blood plasma osmolarity nmlly ranges from 450-800 mOsm
T or F |
False
nml blood plasma osmolarity is 300 mOsm |
