LECTURER: IDOL L. BONDOC, M.D., R.N.

, MAN

URINARY SYSTEM

PRELIMINARIES (VIDEO)

Video of urinary system

COMPONENT PARTS: 1. KIDNEYS,

2. URETERS, 3. URINARY BLADDER, AND

4. URETHRA.

EMBRYOLOGY
3 Overlapping kidney systems:
1. Pronephros rudimentary and

nonfunctional; up to 4th week time

2. Mesonephros fxn for a short 3. Metanephros appears in the 5th

wk; definitive kidney

KIDNEYS: LOCATION AND STRUCTURE

RETROPERITONEAL

Extend from T12 to L3 vertebra

Right kidney is positioned slightly lower than the left 12cms x 6cms x 3 cms or 5 inches x 2.5 inches x 1 inch Size of a large bar soap

KIDNEYS: LOCATION AND STRUCTURE

RENAL HILUM ureters, renal blood vessels,

nerves, enter or exit the kidney at the hilum

KIDNEYS
Bean shaped, reddish brown

120-170 gms. (ave: 150 gms)

Retroperitoneal organs

Extend from T12-L3

Segments Relation

to

surrounding

organs

NEPHRON
>Secretory part of kidney concerned with urine formation >1- 4 million nephrons per kidney >Parts: Renal corpuscle, PCT, Henles Loop, & DCT.

Kidney Blood Supply

> Renal artery from abdominal aorta at level of L1 L2. >Segmental artery >Interlobar artery =bet. renal pyramids >Arcuate artery =at corticomedullary junction >Interlobular artery =bet. medullary rays >Afferent arteriole =gives rise to glomerulus >Efferent arteriole >Peritubular capillaries supplies PCT & DCT Vein: Drain into corresponding veins

Urine formation (video)

CHARACTERISTICS OF NORMAL AND ABNORMAL URINE

Urine Amount
Normal: 1200-1500 ml Abnormal: Under 1200 ml
Decreased fluid intake Kidney failure

Abnormal: Over 1500 ml

Diabetes Diuretics Increased fluid intake

Urine Color
Normal: Straw, amber, or transparent

Urine Color
Abnormal:
Dark amber Insufficient fluid intake resulting in concentrated urine Cloudy Infectious process Dark orange Drugs (e.g., Pyridium)

Red or dark brown Disease process causing blood in urine

Urine Consistency
Normal: Clear liquid Abnormal: Mucous plugs, viscid, thick
Infectious process

Urine Odor
Normal: Faint aromatic Abnormal: Offensive
Infectious process

Urine Sterility
Normal: No microorganisms present Abnormal: Microorganisms present
Infection of the urinary tract

Urine pH
Normal: 4.5 to 8 Abnormal: Over 8
Urinary tract infection

Abnormal: Under 4.5

Uncontrolled diabetes, starvation, dehydration

Urine Specific Gravity

Normal: 1.010 to 1.025 Abnormal: Under 1.010
Diabetes insipidus, kidney disease, overhydration

Abnormal: Over 1.025

Diabetes mellitus, underhydration

Urine Glucose
Normal: Not present Abnormal: Present
Diabetes mellitus

Urine Ketone Bodies (Acetone)

Normal: Not present Abnormal: Present
Diabetic coma, starvation, prolonged vomiting

Urine Blood
Normal: Not present Abnormal: Occult
Kidney disease

Abnormal: Bright red

Hemorrhage

MICTUIRTION REFLEX (VIDEO)

Ureters
>Convey urine to bladder >10 inches (length) >Parts: 1.Renal Pelvis
2. Abdominal/False Ureter 3. Pelvic/True Ureter 4. Intravesical Ureter >MUCOSA: Transitional epithelium

Ureter Constrictions
>Three (3) Renal pelvis joins ureter (Ureteropelvic junction)

Ureter crosses pelvic brim kinked

Pierces bladder wall (Ureterovesico junction)

Urinary Bladder
>Extraperitoneal organ behind symphysis pubis >Receptacle for urine storage >Strong muscular walls >MUCOSA: Transitional Epith

Bladder Parts
1. Fundus central & sup-post, expands freely, rises above pubic crest

2. Apex Ant-sup portion, connected to ant. abdominal wall by median umbilical lig
3. Body post-inf, has the two ureteric orifices 4. Base lies on pelvic floor, has the TRIGONE (Triangular area = base is a line drawn between two ureteric orifices & apex formed by internal urethral meatus). 5. Neck continuous with urethra

Urethra
Male >20 cms (length) >Starts from bladder neck to external meatus of Glans penis >Parts: Prostatic, Membranous, Spongy/Penile urethra

Urethra
Female Urethra >4 cms long >corresponds to the prostatic & membranous portions of male >Lining Epith: Proximal part: Transitional Distal Part: Stratified squamous, nonkeratinizing

FLUID, ELECTROLYTE, AND ACID BASE BALANCE

1. Maintaining Water and Electrolyte Balance of Blood
a. b. c.

Body fluids and fluid compartments The link between water and salt Regulation of water intake and output

2. Maintaining Acid Base Balance of Blood

a. b. c.

Blood buffers Respiratory system controls Renal mechanisms

BLOOD BUFFERS

Back to Basics:
An acid is a substance that

increases H+ concentration, thus reducing pH.

A base is a proton acceptor .,

bases decrease H+ concentrations and raise the pH.

 Acids are produced continuously during normal metabolism, although the blood concentration of free

hydrogen ion ( H+) vary between narrow limits.

The acids handled by the body daily

are about 20,000 mmol of volatile and 40- 80 mmol of non-volatile acids.

 Relatively constant H+ concentrations are important physiologically, as small changes in pH affect enzyme activity and thus metabolism.

 The immediate defense against changing H+ concentrations is provided buffers, while excretion is regulated by adaptive responses in the lungs and kidney.

The changes in ECF (H+) conc. or (pH) are regulated by :

Buffers: v. rapid

temporarily traps acids or bases

Respiratory response: rapid gets rid of or retains CO2 Renal response: slow

excretes of fixed acids & retains or excretes HCO3-

CO2

H+ + HCO3- H2CO3 CO2 + H2O

Removed by lungs

Tissues
CO2

ECF CO2
HCO3Cl -

Erythrocyte
CO2 + H2O
Carbonic anhydrase

HCO3- +H+
Cl -

+ HbO2

O2

O2 + HHb

END OF LECTURE

GOOD LUCK ON YOUR FINAL EXAM

Disturbance of the Acid-Base Status

Acidosis : Alkalosis: pH > 7.4

pH < 7.4

HCO3- < 20/1 H2CO3-

HCO3- > 20/1 H2CO3 HCO3- = metabolic

HCO - = metabolic
3

H2CO3- = respiratory

H2CO3- = respiratory