WELCOMEWELCOME

University of BaghdadCollege of Nursing

Department of Basic Medical Sciences

Overview ofAnatomy and Physioloy –II

Second Year Students

Asaad Ismail Ahmad , Ph.D.Electrolyte and Mineral Physiology

asaad50.2011@gmail.com2012 - 2013

University of BaghdadCollege of Nursing

Department of Basic Medical Sciences

Overview ofAnatomy and Physioloy –II

Second Year Students

Asaad Ismail Ahmad , Ph.D.Electrolyte and Mineral Physiology

asaad50.2011@gmail.com2012 - 2013

ANATOMY AND PHYSIOLOGY - II

Brief Contents1- Cardiovascular System2- Blood3- Lymphatic System4- Urinary System5- Male Reproductive System6- Female Reproductive System7- Sensory Function

Asaad Ismail Ahmad, Ph.D in Electrolyte and Mineral PhysiologyCollege of Nursing – University of Baghdad / 2012 – 2013

asaad50.2011@gmail.com

Brief Contents1- Cardiovascular System2- Blood3- Lymphatic System4- Urinary System5- Male Reproductive System6- Female Reproductive System7- Sensory Function

Asaad Ismail Ahmad, Ph.D in Electrolyte and Mineral PhysiologyCollege of Nursing – University of Baghdad / 2012 – 2013

asaad50.2011@gmail.com

Text book

Martini FH. Fundamentals of Anatomy andPhysiology, 5th ed. Prentice Hall, New Jersey,2001.

Text book

Martini FH. Fundamentals of Anatomy andPhysiology, 5th ed. Prentice Hall, New Jersey,2001.

References:1.Barrett KE, Barman SM, Boitano S, Brooks HL. Ganong's Review of Medical

Physiology, 23rd ed. McGraw Hill, Boston, 2010.2.Drake RL, Vogl W, Mitchell AWM. Gray's Anatomy for Students. Elsevier,

Philadelphia, 2005.3.Goldberger ,E. 1975.A Primer of Water Electrolyte and Acid-Base

Syndromes. 5th ed., Lea and Febiger ,Philadelphia.

4. Martini, FH and Welch K. Applications Manual Fundamentals of Anatomyand Physiology,4th ed., Prentice Hall, NewJersey, 1998.

5.Maxwell, MH and Kleeman CR. 1980.Clinical Disorders of Fluid andElectrolyte Metabolism. McGraw-Hill Book Company, New York.

6.McKinley M, and O'Loughlin VD. Human Anatomy, McGraw Hill, Boston,2006.

7.Nutrition Foundation.1984.Present Knowledge in Nutrition. 5th ed.,Nutrition Foundation, Inc , Washington, D.C.

8.Vander A, Sherman J, Luciano D., Human Physiology, 7th ed., McGraw Hill,Boston, 1998.

References:1.Barrett KE, Barman SM, Boitano S, Brooks HL. Ganong's Review of Medical

Physiology, 23rd ed. McGraw Hill, Boston, 2010.2.Drake RL, Vogl W, Mitchell AWM. Gray's Anatomy for Students. Elsevier,

Philadelphia, 2005.3.Goldberger ,E. 1975.A Primer of Water Electrolyte and Acid-Base

Syndromes. 5th ed., Lea and Febiger ,Philadelphia.

4. Martini, FH and Welch K. Applications Manual Fundamentals of Anatomyand Physiology,4th ed., Prentice Hall, NewJersey, 1998.

5.Maxwell, MH and Kleeman CR. 1980.Clinical Disorders of Fluid andElectrolyte Metabolism. McGraw-Hill Book Company, New York.

6.McKinley M, and O'Loughlin VD. Human Anatomy, McGraw Hill, Boston,2006.

7.Nutrition Foundation.1984.Present Knowledge in Nutrition. 5th ed.,Nutrition Foundation, Inc , Washington, D.C.

8.Vander A, Sherman J, Luciano D., Human Physiology, 7th ed., McGraw Hill,Boston, 1998.

TENTH LECTUREPhysiology of Urinary System

1. Urine Formation2. Micturation3. Composition of Urine and

Urinalysis

Asaad Ismail Ahmad, Ph.D in Electrolyte and Mineral PhysiologyCollege of Nursing – University of Baghdad / 2012 – 2013asaad50.2011@gmail.com

TENTH LECTUREPhysiology of Urinary System

1. Urine Formation2. Micturation3. Composition of Urine and

Urinalysis

Asaad Ismail Ahmad, Ph.D in Electrolyte and Mineral PhysiologyCollege of Nursing – University of Baghdad / 2012 – 2013asaad50.2011@gmail.com

GENERAL KIDNEYS FUNCTIONS

1-Maintaining volume of body fluids(ECF & ICF)

2-Maintaining composition of bodyfluids

3-Formation of urine (organization ofwaste products)

1-Maintaining volume of body fluids(ECF & ICF)

2-Maintaining composition of bodyfluids

3-Formation of urine (organization ofwaste products)

KIDNEYS FUNCTIONS(Formation of Urine)

MECHANISMS OF KIDNEY FUNCTIONSp.953

1- FILTRATION2- REABSORPTION3- SECRETION4- EXCRETION

1- FILTRATION2- REABSORPTION3- SECRETION4- EXCRETION

Schematic of relations between bloodvessels and tubular structures

FILTRATIONFILTRATION

Factors Glomerular Filtration

Depends on1- Pressure gradient across the filtration slit(

endothelium, basal membrane,epithelium”podocytes”.

2- Blood circulation through out the kidneys.3- Permeability of filtration barrier.4- Filtration surface.

Depends on1- Pressure gradient across the filtration slit(

endothelium, basal membrane,epithelium”podocytes”.

2- Blood circulation through out the kidneys.3- Permeability of filtration barrier.4- Filtration surface.

Hormones affecting filtration

1- Antidiuretic hormone (ADH):reabsorption of H2O.

2- Aldosterone: reabsorption ofNa+

3-Atrial natriuretic peptide:decrease reabsorption of Na+

1- Antidiuretic hormone (ADH):reabsorption of H2O.

2- Aldosterone: reabsorption ofNa+

3-Atrial natriuretic peptide:decrease reabsorption of Na+

HORMONES EFFECT ON RENALFUNCTIONS

1- ADH ‘Antiduretic hormone’2- PTH ‘Parathyroid hormone’3- Aldosterone4- Angeotinsin II5- ANP ‘ Atrial Natriuretic hormone “

1- ADH ‘Antiduretic hormone’2- PTH ‘Parathyroid hormone’3- Aldosterone4- Angeotinsin II5- ANP ‘ Atrial Natriuretic hormone “

Hormones Secreted by Kidneys

1- Renin2- Erythropoietin (EPO)3- Calcitriol (Active vitamin D)4- Prostaglandins

1- Renin2- Erythropoietin (EPO)3- Calcitriol (Active vitamin D)4- Prostaglandins

REABSORPTIONREABSORPTION

Reabsorption – Proximal convolutedtubules

2/3 of filtered salt and water, and all filteredorganic solutes (primarily glucose and aminoacid)

1- 75 – 80 % water2- Na+, Cl-, HCO3-, K+ , Ca2++ , Mg2++, HPO4—3- Glucose and Amino acids

2/3 of filtered salt and water, and all filteredorganic solutes (primarily glucose and aminoacid)

1- 75 – 80 % water2- Na+, Cl-, HCO3-, K+ , Ca2++ , Mg2++, HPO4—3- Glucose and Amino acids

MECHANISMS OF TUBULARREABSORPTION p.958

1- Passive mechanism2- Active mechanism3- Paracellular route4- Diffusion5- Osmosis

1- Passive mechanism2- Active mechanism3- Paracellular route4- Diffusion5- Osmosis

SECRETIONSECRETION

Substances Secreted byRenal Tubules p.9651- Hydrogen ion (H+)2- Potassium ion (K+)3- Organic cation ( OC+) e.g.

epinephrine, choline, serotonin, atropine,quinine, cimitidine, morphine, etc

4- Organic anion (OA-) e.g.PAH, phenol red, hippurate, urate,penicillin, barbiturate, diuretics,conjugates,etc

1- Hydrogen ion (H+)2- Potassium ion (K+)3- Organic cation ( OC+) e.g.

epinephrine, choline, serotonin, atropine,quinine, cimitidine, morphine, etc

4- Organic anion (OA-) e.g.PAH, phenol red, hippurate, urate,penicillin, barbiturate, diuretics,conjugates,etc

SIGNIFICANT DIFFERENCES BETWEEN SOLUTE CONCENTRATIONS OFURNE AND PLASMA P. 953

RENIN: Proteolytic enzyme synthesized,stored, and secreted by the juxtaglomerular

cells of the kidney, it play a role inregulation of blood pressure by catalyzing

the conversion of the plasmaangeotinsinogen to angeotinsin I.

ANGEOTINSIN - I. Convert to angeotinsin II inthe lungs .

ANGEOTINSIN - II. IS A POTENTVASOCONSTRICTORS , and a powerful stimulus

of aldosterone secretion

RENIN: Proteolytic enzyme synthesized,stored, and secreted by the juxtaglomerular

cells of the kidney, it play a role inregulation of blood pressure by catalyzing

the conversion of the plasmaangeotinsinogen to angeotinsin I.

ANGEOTINSIN - I. Convert to angeotinsin II inthe lungs .

ANGEOTINSIN - II. IS A POTENTVASOCONSTRICTORS , and a powerful stimulus

of aldosterone secretion

Structure of the juxtaglomerularapparatusfunction.

Urination (Micturation)

Process of disposing urine from urinary bladdder through theurethra to outside the body

The process of urination is usually under voluntary control

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

Urinary retention: is the inability to urinate

Nocturia : is the incontenence during the night (effects ofemotions)

Process of disposing urine from urinary bladdder through theurethra to outside the body

The process of urination is usually under voluntary control

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

Urinary retention: is the inability to urinate

Nocturia : is the incontenence during the night (effects ofemotions)

Micturition Reflex1- Activated when the urinary bladder wall is stretched, it result

in urination.2- This reflex occur in spinal cord, especially in the sacral region,

that is modefied by higher center in the brain, the pons andcerebrum.

3-The presence of urine in the bladder stimulate stretchreceptors ,which produces action potential.

4- The action potential is carried by sensory neurons to thesacral segments of the spinal cord through the pelvic nerves,the parasympathetic fibers carry action potentials to theurinary bladder in the pelvic nerves.

5- The pressure in urinary bladder increases rapidly once itsvolume exceeds approximately 400- 500 ml.

1- Activated when the urinary bladder wall is stretched, it resultin urination.

2- This reflex occur in spinal cord, especially in the sacral region,that is modefied by higher center in the brain, the pons andcerebrum.

3-The presence of urine in the bladder stimulate stretchreceptors ,which produces action potential.

4- The action potential is carried by sensory neurons to thesacral segments of the spinal cord through the pelvic nerves,the parasympathetic fibers carry action potentials to theurinary bladder in the pelvic nerves.

5- The pressure in urinary bladder increases rapidly once itsvolume exceeds approximately 400- 500 ml.

Steps of Micturition

1- Distention of urinary bladder.2- Stimulation of sensory fiber (afferent),send impulses

to micturition center in spinal cord.3- Stimulation of parasympathetic nerve fiber (motor)

to :a- to stimulate detrusor muscle in U.B.b- relax internal urethral sphincter.

4- Sensation for urination as urgent.

1- Distention of urinary bladder.2- Stimulation of sensory fiber (afferent),send impulses

to micturition center in spinal cord.3- Stimulation of parasympathetic nerve fiber (motor)

to :a- to stimulate detrusor muscle in U.B.b- relax internal urethral sphincter.

4- Sensation for urination as urgent.

Continue: Steps of Micturition5- Urination prevented by

a- contraction of external urethral sphincter.b- inhibition of micturition reflex by cerebral

cortex6- Micturition (urination) occur after decision to

a- voluntry relaxation of external urethralsphincter.

b- facilitation by impulsee fromhypothalamus.

7- Inactivation of micturition reflex center, andrelaxation of detrusor muscle

5- Urination prevented bya- contraction of external urethral sphincter.b- inhibition of micturition reflex by cerebral

cortex6- Micturition (urination) occur after decision to

a- voluntry relaxation of external urethralsphincter.

b- facilitation by impulsee fromhypothalamus.

7- Inactivation of micturition reflex center, andrelaxation of detrusor muscle

Measurement of renal function

A simple means of estimating renal function isto measure pH, blood urea nitrogen,creatinine, and basic electrolytes (includingsodium, potassium, chloride, andbicarbonate). As the kidney is the mostimportant organ in controlling these values,any derangement in these values couldsuggest renal impairment.

A simple means of estimating renal function isto measure pH, blood urea nitrogen,creatinine, and basic electrolytes (includingsodium, potassium, chloride, andbicarbonate). As the kidney is the mostimportant organ in controlling these values,any derangement in these values couldsuggest renal impairment.

Clearance

1- Ability of the kidneys to clear plasma fromdifferent products.

2- Glomerular Filtration Rate (GFR )3- GFR = U x V / P

U = concentration of inulin in urineV = volume of urineP = concentration of inulin in the plasma

Normal GFR is around 125 ml/min (7.5 l/h)

1- Ability of the kidneys to clear plasma fromdifferent products.

2- Glomerular Filtration Rate (GFR )3- GFR = U x V / P

U = concentration of inulin in urineV = volume of urineP = concentration of inulin in the plasma

Normal GFR is around 125 ml/min (7.5 l/h)

Assessing Renal function/Measures of dialysis

1- Glomerular filtration rate2- Creatinine clearance3- Renal clearance ratio4- Urea reduction ratio5- Kt/V6- Standardized Kt/V7- Hemodialysis product8- PAH clearance (Effective renal plasma flowExtraction ratio)

1- Glomerular filtration rate2- Creatinine clearance3- Renal clearance ratio4- Urea reduction ratio5- Kt/V6- Standardized Kt/V7- Hemodialysis product8- PAH clearance (Effective renal plasma flowExtraction ratio)

Hemodialysis Process p.970

Plugged into dialysis

Urinary Tract Infection

THANK YOUTHANK YOU