Portage pathophysiology module 8 (Questions and Answers A+ Graded 100% Verified)

Portage pathophysiology module 8 (Questions and Answers A+ Graded 100% Verified) Describe the location of the hilus and its significance. CORRECT ANSWER: The hilus is a concave cleft, and it is at this point where the ureters, blood vessels, and nerves enter the kidney. Describe the functions of the nephron. CORRECT ANSWER: 1. control the concentration of water and soluble materials by filtering the blood 2. reabsorbing needed materials and excreting waste products as urine 3. regulate blood pressure and blood volume 4. regulate pH and electrolytes Name the structures of the nephron and describe their individual functions. CORRECT ANSWER: Afferent arteriole: brings blood to glomerulus glomerulus: capillary bed, capillaries contain pores that allow water, glucose, amino acids, and nitrogenous wastes to flow into Bowman's capsule, but keeps RBCs and proteins in the capillaries. Bowman's capsule: hold filtrate, which gets directed to proximal convoluted tubule Proximal convoluted tubule: reabsorbs Na, Cl, HCO3, K, H2O, glucose, amino acids. secretes H+, organic acids and bases. Descending loop of Henle: reabsorbs water Ascending loop of Henle: reabsorb Na, Cl, K, Ca, HCO3-, Mg. secretes H+ distal convoluted tubule: reabsorbs Na, Cl, Ca, Mg, K, HCO3-, water (via ADH action) vasa recta: peritubular capillary bed along loop of Henle collecting duct: receives filtrate from distal convoluted tubule, filtrate flows towards renal pelvis, to ureters to be excreted. Compare and contrast the renal cortex and renal medulla. Discuss the structures found in each. CORRECT ANSWER: Renal cortex: More superficial portion of kidney, lies just below renal membrane, contains the glomerulus and Bowman's capsule, proximal convoluted tubule and distal convoluted tubule portion of nephrons. Renal medulla: deeper portion of kidney, beneath the renal cortex. Contains loop of Henle portions of nephrons and collecting ducts. Renal pyramids make up the renal medulla. Explain the difference between cortical nephrons and juxtamedullary nephrons. CORRECT ANSWER: Cortical nephrons make up 85% of all nephrons. They originate superficially in the cortex and have shorter loops of Henle that extend only a short distance into the medulla. Juxtamedullary nephrons make up the remaining 15% of all nephrons. They originate deeper in the cortex, and their loops of Henle are thinner and extend into the medulla entirely. Explain the differences in the two systems providing the blood supply to the nephron. How does their structure determine their role? CORRECT ANSWER: The glomerulus receives blood from the afferent and efferent arterioles, creating a high-pressure system in the Bowman's capsule. The capillaries in the glomerulus are porous and allow solutes and fluid to flow out easily. The peritubular capillaries are low-pressure, from efferent arterioles creating the vasa recta surrounding the loop of Henle. The high amount of contact the vasa recta makes with the loop of Henle allows for rapid solute and fluid transfer. (better suited for reabsorption) Name two specialized structures of the glomerular capillaries that contribute to the filtration of blood. CORRECT ANSWER: fenestrations: pores that allow solutes and fluid to pass through podocytes: form slit pores that allow filtrate to pass through List the 4 segments of the nephron tubule. CORRECT ANSWER: proximal convoluted tubule, loop of Henle, distal convoluted tubule, collecting tubule What are the 3 processes involved in urine formation? Describe where they occur. CORRECT ANSWER: 1. glomerular filtration: occurs in the glomerulus 2. tubular reabsorption: occurs in proximal convoluted tubule, loop of Henle and distal convoluted tubule 3. tubular secretion: occurs in proximal convoluted tubule, loop of Henle and distal convoluted tubule What is the norm value for the GFR? Discuss why maintenance of this value is important. CORRECT ANSWER: 120-125 mL/ min. If GFR rate is too rapid, solutes do not have enough time to diffuse, creating a build-up of wastes in the bloodstream and/or a loss of important nutrients and electrolytes. If GFR was too slow, nearly all solutes would be re-absorbed, leading to toxic build-up of wastes. List the 3 regulatory mechanisms of the GFR. CORRECT ANSWER: 1. renal autoregulation: afferent arteriole constricts to decrease GFR, efferent arteriole constricts to increase GFR 2. nervous system: increased sympathetic activity constricts afferent arteriole, leading to decreased GFR 3. RAAS: increased RAAS activity leads to increased reabsorption of sodium and water. This increases blood volume which increases GFR Be familiar with the RAA system and Figure 8.4 CORRECT ANSWER: hypotension/ hypovolemia trigger renin release from juxtaglomerular cells. Renin cleaves angiotensinogen into angiotensin 1. ACE converts angiotensin 1 into angiotensin 2 in the lungs. Angiotensin 2 triggers thirst response, vasoconstriction and aldosterone secretion. Aldosterone triggers DCT to reabsorb Na and H2O (increases blood volume and BP!!) Be familiar with the process of tubular reabsorption and Figures 8.5 and 8.6 CORRECT ANSWER: PCT: reabsorbs electrolytes, glucose, AA. secretes H+, organic acids and bases Descending loop of Henle: reabsorbs water Ascending loop of Henle: reabsorbs electrolytes, secretes H+ DCT: reabsorbs electrolytes, secretes K+, H+ List 3 ways that the kidney acts as an endocrine organ. CORRECT ANSWER: 1. vitamin D activation 2. erythropoietin production 3. renin-angiotensin-aldosterone system Describe the action of ADH. CORRECT ANSWER: ADH acts on the collecting tubule to increase water absorption. ADH opens aquaporins in the collecting duct, allowing additional water back into the bloodstream. The effect is an increase in blood volume, and a decrease in urine volume Describe the action of Aldosterone. CORRECT ANSWER: Aldosterone acts to place several types of ion channels inside the cells of the collecting ducts. Increases blood pressure and blood volume Define hyponatremia using blood values. CORRECT ANSWER: Na < 135 mEq/ L Be familiar with hyponatremia pathology, clinical presentation, and treatment. CORRECT ANSWER: etiology: vomiting, diarrhea, sweating, diuretics, increased ADH, hyperglycemia. presentation: hypovolemia, hypotension, oliguria, edema, N/V/D. treatment: depends on cause (hypertonic hyponatremia vs hypotonic hyponatremia) Define hypernatremia using blood values. CORRECT ANSWER: Na > 145 mEq/ L Be familiar with hypernatremia pathology, clinical presentation, and treatment. CORRECT ANSWER: etiology: excessive water loss or excessive sodium gain. high dietary salt intake, loss of body water, decreased water intake. manifestation: hypertension, thirst, dry skin, decreased urine output treatment: treat underlying cause, replenish fluids orally/ IV Define hypokalemia using blood values. CORRECT ANSWER: blood potassium levels <3.5 mEq/L. Be familiar with hypokalemia pathology, clinical presentation, and treatment. CORRECT ANSWER: etiology: dietary deficiency, diuretics, vomiting, diarrhea, insulin causing fluid shift from ICF --> ECF presentation: arrhythmia, hypotension, metabolic alkalosis treatment: increased oral intake of K, IV Define hyperkalemia using blood values. CORRECT ANSWER: potassium > 5 mEq/ L Be familiar with hyperkalemia pathology, clinical presentation, and treatment. CORRECT ANSWER: etiology: decreased renal excretion d/t renal failure, K+ sparing diuretics; excessively rapid administration Presentation: muscle weakness, abd. cramping, cardiac arrest, Vfib, SOB. treatment: calcium administration, NaHCO3, insulin and glucose. Define hypocalcemia using blood values. CORRECT ANSWER: calcium <8.5 mg/ dL Be familiar with hypocalcemia pathology, clinical presentation, and treatment. CORRECT ANSWER: etiology: impaired ability to draw Ca from bone; deposition of Ca in soft tissue; increased Ca loss from kidneys, hypoparathyroidism presentation: arrhythmia, hypotension, muscle twitching/cramps, fractures, bone pain, osteomalacia treatment: IV calcium gluconate or calcium chloride. if non-emergent: oral supplement Define hypercalcemia using blood values. CORRECT ANSWER: Ca > 10.5 mg/ dL Be familiar with hypercalcemia pathology, clinical presentation, and treatment. CORRECT ANSWER: etiology: hyperparathyroidism, bone breakdown d/t neoplasm, excessive Ca supplements presentation: low neuromuscular excitability, confusion, osteopenia/porosis, arrhythmia treatment: fluid replacement, diuretics and NaCl to increase urine excretion of Ca Define hypomagnesemia using blood values. CORRECT ANSWER: Mg < 1.8 mg/dL Be familiar hypomagnesemia pathology, clinical presentation, and treatment. CORRECT ANSWER: etiology: malnutrition, diarrhea, alcoholism presentation: tachycardia, hypertension, arrhythmia, personality changes treatment: Mg replacement Define hypermagnesemia using blood values. CORRECT ANSWER: Mg > 3.0 mg/ dL Be familiar with hypermagnesemia pathology, clinical presentation, and treatment. CORRECT ANSWER: etiology: renal insufficiency, overconsumption of Mg foods/supps presentation: hyporeflexia, musc. weakness, low BP, resp. paralysis, cardiac arrest treatment: IV calcium to counteract Mg effects, dialysis What are the 3 mechanisms of control for blood pH. CORRECT ANSWER: 1. chemical buffer system 2. brain stem respiratory system 3. RAAS Be familiar with Table 8.2 and be able to determine whether a patient is in respiratory or metabolic acidosis/alkalosis and compensatory mechanism. CORRECT ANSWER: --- What are the common causes of acute postinfectious glomerulonephritis? CORRECT ANSWER: staph bacteria, viral infections, parasite, group A beta-hemolytic streptococci ANTIBODIES. Discuss risk factors for the formation of renal calculi. CORRECT ANSWER: levels of stone components in the blood and urine, anatomical changes of the urinary tract structures, metabolic and endocrine function, dietary and intestinal absorption, past history of UTIs, and supersaturated urine. Be able to list and describe the 4 types of kidney stones. CORRECT ANSWER: 1. calcium stones: most common type. due to increased calcium in blood, from bone disease, immobility, hyperparathyroidism 2. magnesium ammonium phosphate stones: due to alkaline urine (usually from bacteria) 3. uric acid stones: usually coincide with gout, form with acidic urine 4. cystine stones: result from genetic defect of cystine absorption. most commonly seen in children Describe the differences between renal-colic pain and non-colicky pain. CORRECT ANSWER: renal colic pain: small stones cause stretching of collecting ducts or ureter. acute, sharp pain. "flank pain" non-colicky pain: stones distend renal pelvis and calyx. deep, dull ache Be familiar with various diagnostic tests and treatments for renal Calculi. CORRECT ANSWER: tests: urinalysis, x-ray, ultrasonography Treatments: most patients pass stones on their own. can provide pain support, antibiotics if concurrent UTI, education on stone prevention. if patient unable to pass stone: Ureteroscopic removal, percutaneous nephrolithotomy, extracorporeal shockwave lithotripsy What are the 3 categories of acute renal failure? CORRECT ANSWER: prerenal, postrenal, intrarenal What are the 2 types of ATN? CORRECT ANSWER: ischemic ATN: occurs after surgery, trauma, burns nephrotoxic ATN: exposure to drugs/ nephrotoxic agents (vanco, gentamycin, chemo drugs, radiocontrast agents) What are the 3 phases of ATN? CORRECT ANSWER: initiation phase: hours to days. time between injury and tubular damage maintenance phase: decreased GFR, metabolic waste retention, low urine output, fluid retention recovery phase: tubular repair, urine output increases, BUN and creatinine levels return to normal What blood values are closely monitored in renal failure? CORRECT ANSWER: BUN, creatinine Be familiar with the stages of kidney failure and table 8.2. CORRECT ANSWER: --- Describe the process of Hemodialysis. CORRECT ANSWER: Vascular access is obtained via arteriovenous fistula. Patients are connected to the dialyzer via a catheter. Blood runs into the machine, where it is filtered through the dialyzing membrane and dialysate fluid. Waste products diffuse into the dialysate, and filtered blood returns to the patient. Dialysis treatments usually occur 3 times per week for several hours per treatment Describe the process of peritoneal dialysis. CORRECT ANSWER: In peritoneal dialysis, a catheter is inserted into the patient's peritoneum via their abdomen. Dialysate fluid enters their abdomen, and the peritoneum acts as a dialyzing membrane. After wastes have been filtered, the fluid is drained out of the person's abdomen. This type of dialysis can be done at home What are the determinants of transplantation success? CORRECT ANSWER: Overall health of the recipient, the degree of compatibility between the donor and the recipient, and the management of re