Urinary System Anatomy and Physiology Part I

Urinary System Kidneys (2) Most important excretory organ Eliminate waste

Ureters (2) Bladder (1) Urethra (1) Nephron Unit Functional unit of the kidney Formation of urine Tubular and vascular structures

Kidney Location and Protection

Kidneys are located in the posterior wall of the abdominal cavity In the retrope ritoneal space Connective tissue (renal fascia) hold the kidneys in place Adipos e tissue cushion the kidneys The lower rib cage partially enclose the kidney and protect them

Urinary System Anterior/Posterior Views

Kidney Structures

Kidney is reddish-brown Looks like a bean Approximately 4 inches x 2 inches Hilu s indentation where blood vessels and structures enter or exit the kidney Three Regions in the kidney if sliced in half renal cortex, renal medulla, renal pelvi s

Average adult kidney weighs 113-170 g. 10 12 cm long. 6 cm wide. 2.5 cm thick. R ight kidney is lower than the left due to location of liver.

Adrenal gland lies on top of each kidney. Renal parenchyma is divided into two p arts: ~ Cortex ~ Medulla

Renal Cortex Light, outside region Cortex means bark Contains: Nephron

Renal Medulla

Dark, triangular structure Form small cone shaped regions called renal pyramids Each pyramid is separated by renal columns The lower ends of the pyramids point to the renal pelvis

Renal Medulla Contains: Loops of Henle, Vasa Recta and collecting ducts of the juztamedullary nephrons.

Each kidney contains 8 -18 pyramids. Pyramids drain into 4 13 minor calices. 2 3 major calices.

Renal pelvis

A basin that collects the urine made by the kidney and helps form the upper end of the ureter The edges of the renal pelvis closest to the renal pyramids are ca lled calices Calices collect the urine formed in the kidney

Renal pelvis Is the beginning of collecting system and composed structures that are designed to COLLECT and TRANSPORT URINE.

How do they work?

Need a blood supply Brought to the kidney via the renal artery Renal artery stem s from the abdominal aorta 20-25% of cardiac output goes to the kidneys Smaller arteries supply blood to the nephron unit Blood leaves the kidney via the renal veins The renal veins empty into the inferior vena cava

Functions of the Kidneys Excrete nitrogenous waste from the body Urea Ammonia Creatinine

Regulate blood volume Help regulate electrolyte content of the blood Regulate ac id-base balance (pH) Regulate blood pressure Regulates red blood cell production

The Formation of Urine

The Nephron Unit Each kidney contains about 1 million nephron units The number d oes not increase after birth They cannot be replaced if damaged 2 parts Tubular component (renal tubule) Vascular component

Renal Tubules

Glomerular capsule (Bowmans Capsule) C shaped capsule surrounding the glomerulus Gl omerulus cluster of capillaries Proximal convoluted tubule Loop of Henle ascending and descending limb Distal Convoluted tubule Collecting duct

Nephron

Renal Vasculature

Receives blood from the renal artery Renal artery branches into the afferent art erioles (Branches to form glomerulus) Afferent arterioles feed into Bowmans capsu le The efferent arterioles exit Bowmans capsule The efferent arterioles form the peritubular capillaries The peritubular capillaries empty into the venules, larg e veins, and then into the renal veins It is imperative you know the relationshi p between the tubular and vascular structures.

Urine Formation

Formed in the nephron unit Water and dissolved substances move through the renal tubules and vessels Three processes are involved in urine formation Glomerular filtration Tubular reabsorption Tubular secretion

Normal Urine

Clear and pale to deep yellow or amber Slightly aromatic in odor Slightly acidic 5.0 8.0 With a sp. Gravity of 1.010 1.030 (+) NA, K ions, urea uric acid, creat inin, ammonia, and HCO3 ions (-) Glucose, CHON, RBC, and WBC and bile pigments

Composition of Urine

Sterile 95 % water Nitrogen containing waste urea, uric acid, ammonia, creatinin e Electrolytes Light yellow color of urine is due to a pigment called urochrome Urochrome is formed from the breakdown of hemoglobin in the liver

Urine Specific Gravity

Ratio of the amount of solute to the total volume Solute = substance dissolved i n the urine The greater the solute = greater the specific gravity Concentrated U rine = high specific gravity Ex. dehydration Ex. Overhydration, diabetes insipidus

Dilute Urine = low specific gravity

Urine Characteristics

Amount 1500 ml in 24 hours pH average 6.0 Specific Gravity heavier than water (1 .0101.030) Color yellow (amber, straw colored, concentrated, orange, brown, red, sediment, clear or cloudy) Dehydrated = deep yellow, dark Overhydrated = pale y ellow, colorless

Abnormal Constituents of Urine Albumin (protein) Glucose Red blood cells Hemoglobin White blood cells Ketone bo dies Bilirubin

Urine Testing Urinalysis Microscopic exam Culture and sensitivity Urine dipstick Urine Drug an d alcohol screening 24 hour urine testing

Your Plumbing The Urinary Tract (Ureters, Urinary bladder, Urethra) Ureters Transport urine, they do not alter it in any way Urine moves in response to gravity and muscular movements called peristalsis through ureters.

Your Plumbing

The Bladder

Stores urine temporarily until elimination Located behind the symphasis pubis A distended bladder or full bladder can be palpated above the syphasis in the abdo minal cavity. Bladder has 4 layers Mucous membrane Submucosa Detrusor muscle involuntary smooth muscle Serosa

Contain rugae to allow for stretching Trigone triangular area in the floor of th e bladder

Urination Micturition

Expelling urine from the bladder The urge to urinate (void) happened at about 20 0 ml of urine in the bladder At about 300 ml urine in the bladder, the urge beco mes more uncomfortable Moderately full = 500 ml urine Overdistended bladder may have over 1000 ml urine Bacteria in your bladder doubles every 4 hours. Stimulat ed by stretch receptors

Urethra

Carries urine from the bladder to the outside of the body Internal sphincter pre vents urine from emptying; composed of smooth muscle; involuntary External sphin cter at the upper portion of the urethra allows you to resist the urge to urinat e; composed of skeletal muscle; voluntary Female short, opens to the outside at the urethral meatus Male longer, passes through the prostate gland; carries urin e and sperm

Urinary Retention and Suppression Retention - Inability to void Post operative; anesthesia Bladder dysfunction

Suppression no urine formation Kidney dysfunction

Data Collection & Documentation Characteristics of urine Color Sediment Clear or cloudy Odor

How does the patient/resident void? Urinary diversions? Signs and symptoms Urgency Frequency Burning sensation Hesitancy

What is the Costovertebral Angle? T11 R. Kidney T12 L1 L. Kidney 12th Rib Costovertebral Angle Region to assess for kidney tenderness

Disorders of the Urinary System Glomerulonephritis Polycystic Kidney Pyelonephritis Renal Calculi kidney stones Renal Failure UTI urinary tract infection

As We Age

By age 80 there is a 50% reduction in nephron units; therefore a decreased abili ty to concentrate urine Urinary bladder shrinks and becomes less able to contrac t and relax; therefore the elderly must void frequently Bladder infection incide nce increases Increase in bladder incontinence due to weakened muscles

Functions of Genitourinary System Filtration Reabsorption Secretion Excretion Regulation