Pathophys final- renal & reproductive system
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| nephron | functional unit of kidney
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| Glomerulus | enclosed capillary component; Afferent/efferent blood vessels
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| Tubule- Bowman’s capsule | filtrate; Proximal tubule → Loop of henle →Distal tubule
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| Juxta glomerular apparatus | Function- rennin production
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| Renin-angiotensin-aldosterone system | control of arterial bp; adjust filtrate based on body’s needs
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| kidneys | acid base reg, electrolyte balance, H2O excretion/regulation; autoregulation; erythropoietin; vitamin d synthesis; secretion of prostaglandins
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| Normal makeup of urine |
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| diuresis | increased urine volume
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| ADH | released in hypothalamus; works- in kidneys, prevents production of dilute urine
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| Aldosterone | released in adrenal cortex; works in kidneys
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| retention of potassium | cant be excreted (in kidney dx)
life-threatening- build up of K+; HR changes, cardiac arrest potential (profound cardiac risk); ECG changes (T wave, QRS, PR, P wave, and ST segment changes); N/D/abd cramping
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| acid base balance | Control of production/reabsorption of bicarb; Reabsorb any bicarb from urinary filtrate; Bicarb= small, free movement at glomerulus; Can generate new bicarb in renal tubular cells too
Excretion of some free acid in urine (small amt), other acid buffered
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| GFR | rate of creating initial filtrate which is called ”ultrafiltrate”
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| azotemia | increased urea levels in blood (increased BUN)
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| BUN | Blood Urea Nitrogen
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| Creatinine | endogenous waste product of skeletal muscle
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| Acute vs chronic renal failure | Acute- sudden kidney failure- blood loss, injury, infection- sepsis
chronic- end stage renal dx; months or years of dx
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| acute vs chronic Glomerulonephritis | Acute- often associated with recent acute infection (i.e., Group A strep)
Chronic- advanced stage of a group of kidney disorders, resulting in inflammation and gradual, progressive destruction of the glomeruli
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| Nephritic syndrome | collection of signs (known as a syndrome) associated with disorders affecting the kidneys, more specifically glomerular disorders
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| Nephrotic syndrome | nonspecific disorder in which the kidneys are damaged, causing them to leak large amounts of protein
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| Female Urinary tract | Ureters, bladder, urethra
Increased risk of UTI
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| Male Urinary tract | Ureters, bladder, prostate, urethra
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| micturition | voiding
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| Lower UTI | Decreased emptying of bladder, increased concentration of urine, urinary stasis, obstructed urinary flow; Dysuria, frequency, nocturia, urgency, incontinence, suprapubic pain, Hematuria
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| Upper UTI | Chills, fever, leukocytosis, bacteriuria, pyuria; Flank pain, N/V, fatigue, dysuria, frequency, wgt loss, thirst
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| most common UTI bacteria | Escherichia coli
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| Uncomplicated UTI | occurs usually in young person with no other complicating factors or comorbidities and infection is not recurrent
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| Complicated UTI | occurs recurrently or in someone with other comorbidities or urologic abnormalities or diseases; often they are nosocomial
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| How do bacteria evade these defenses? |
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| What is reflux of urine? Why does it increase risk of UTI? |
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| Nephrolithiasis | calcium stones are most common
UTI, pain, pyuria, hematuria, urgency, N/V, diarrhea
Obstruction, retention, risk renal damage, urosepsis
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| Neurogenic bladder | dysfunction (spastic or flaccid) that results from a lesion of the nervous system → urinary incontinence;
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| Neurogenic bladder cont'd | caused by spinal cord injury, spinal tumor, herniated vertebral disks, MS, congenital disorders, infection, or DM.
Risks- Urinary stasis, need for catheterization – infection, urolithiasis, vesicoureteral reflux, hydronephrosis, kidney damage
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| incontinence | Stress- involuntary loss of urine through an intact urethra as a result of sneezing, coughing, or changing position
Urge- involuntary loss of urine associated w/ strong urge to void that cannot be suppressed
mixed- combo of stress and urge.
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| Urinary retention | Inability to empty the bladder completely during attempts to void → residual urine
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| bladder CA | Tobacco= risk factor
Hematuria= often first sign (microscopic first, then gross)
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| reproductive differentiation | If estrogen present- gonads form into ovaries; if testosterone present- gonads form into 2 testes
8th week of gestation
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| ova & sperm | Ova: Know that females born with total # of ova that mature over time and release with ovulation after puberty (continue 1/month until menopause)
Sperm: Know that males produce sperm after puberty (continues lifelong)
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| puberty | sexual maturation- Gonads produce more sex hormone; Lasts 2-3 yrs; Begins age 8-12 usually (girls before boys); Complete with capability of reproduction
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| Menopause | cessation of menstrual flow
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| GnRH | increased from hypothalamus
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| Gonads | testosterone or estrogen
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| Adrenal cortex | secretes progesterone, androgens produced here
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| Anterior pituitary | secretes LH/ FSH
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| Gonadotropins | Luteinizing hormone and Follicle-stimulating hormone- secreted from pituitary
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| Testes- external male | Production of gametes (sperm) and sex hormones, Seminiferous tubules (spermatogenesis), Leydig cells
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| Penis- external male | Delivery of sperm and elimination of urine, Externally: shaft, glans (foreskin), Internally: urethra, corpora cavernosa, corpus spongiosum
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| Scrotum- external male | Thin, rugated sac, Tunica dartos
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| Vas deferens- external male | Spermatic cord, Storage and propulsion of sperm
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| Epididymis- external male | Sperm maturation, mobility, fertility, Transport sperm to vas deferens
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| internal male | Sperm via epididymis/spermatic cord mixes with semen via ejaculatory duct
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| Bulbourethral glands- internal male | Secrete mucus into urethra
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| Prostate Gland- internal male | Produces and releases prostatic fluid (thin, milky substance w/ alkaline pH); Urine prevented from entering prostatic urethra during ejaculation
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| Seminal Vesicles (behind bladder)- internal male | Produce and release semen (nutritive, glucose-rich fluid); Ejaculatory duct
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| spermatogenesis | development of mature sperm = begins @ puberty and continues lifelong; division= meiosis
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| testosterone | primary androgen
Adrenal glands and Leydig cells of testes
What functions? constant production
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| testosterone- growth and devel | Nervous and skeletal tissue (skeletal muscle, cartilage of larynx); Increased sebaceous gland activity- acne;
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| testosterone- growth and devel (cont'd) | Bone marrow stimulation- increased erythropoietin; Required for spermatogenesis and fluid for ejaculate; Libido; Role in cholesterol and fatty acid metabolism
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| Vaginal | Vaginal wall
Lactobacillus acidophilus
Disease: vaginitis, vaginal cancer
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| Uterus | Base= cervix
Transformation Zone, endometrium
Risk of HPV
Monthly menstrual cycle
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| Function of uterus in pregnancy |
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| Endometriosis | growth of functioning endometrial tissue @ sites outside of uterus; inflammation of endometrium w/in uterus
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| dysfunctional uterine bleeding | heavy or irregular menstrual bleeding, disruption of menstrual cycle
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| uterine polyps/fibroids | benign tumors arising from the myometrium (muscle layer of uterus); overgrowth of endometrial tissue (vessels, etc), may cause abnormal vaginal bleeding
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| Fallopian Tubes | Function- Movement of ova to uterus- Cilia and peristalsis
Often site of fertilization
Disease: Ectopic pregnancy
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| Estrogen and progesterone | what functions?- Produced by ovaries, Cyclical production with surges, Control sexual development, ovarian-menstrual cycle, pregnancy, and lactation
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| Ovaries | female gonads
Ova (separation of follicle to corpus luteum and ovum)
Role of corpus luteum- secretes progesterone
Disease: Ovarian cancer, Ovarian cysts, PCOS
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| Menstrual Cycle | Stages- Follicular/Proliferative → Luteal → Ischemic/Menstrual
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| Follicular/Proliferative Phase | Maturation of follicle; Proliferation of endometrium
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| Luteal/Secretory Phase | Midcycle surge of LH → ovulation (ovarian cycle)l Ovarian follicle→ corpus luteum ; LH → progesterone from corpus luteum → endometrial preparation; Conception or no conception
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| Ischemic/Menstrual Phase | No conception or implantation → ischemia → menstruation and cycle begins again
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| Hormones of menstrual cycle | FSH & LH
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| Breast- gland & tissue | sebaceous & mammary
Adipose tissue + glands/ducts +fibrous (epithelial cells)
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| Functions of breast milk | Nourishment, immunoglobulins, nonspecific antimicrobial factors
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| Estrogen- effect breast tissue | promotes development of lobular ducts and breast growth
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| Oxytocin- effect breast tissue | controls milk let down (increases after delivery)
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| Prolactin- effect breast tissue | increases milk production (increases with continued breast feeding)
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| Progesterone- effect breast tissue | stimulates development of cells lining acini (milk glands)
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| Fibrocystic breast disease | Physiologic nodularity and breast tenderness that increases and decreases with menstrual and hormonal changes
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