THE ENDOCRINE SYSTEM Endocrine glands- ductless glands that produce hormones (PINEAL, PITUTIARY, THRYROID, THYMUS) Exocrine

glands- glands with ducts producing non-hormones (SALIVARY, SEBACEOUS, SWEAT) Eicosaniods- hormone-like substances derived from arachidonic acid and act only on cells in their immediate vicinity (LEUKOTRIENES & PROSTAGLANDIN)

AMINO-ACID BASED HORMONES- the majority of hormones are of this type: 1. 2. Amines- simple hormones derived from amino acid tyrosine (EPINEPHRINE) Protein & peptides- chains of amino acids hooked together (ADH & OXYTOCIN)

STEROID BASED HORMONES- lipid soluble hormones derived from cholesterol (TESTOSTERONE) MAJOR FUNCIONS OF HORMONES: 1. 2. 3. Integrative- reach all the cells of the body and permit different tissue groups to act as a whole in response to internal or external stimuli. Homeostatic- maintenance of internal environment by changing cellular activities (METATBOLISM, PROTEIN SYNTHESIS, PERMEABILITY OF CELL MEMBRANES) Growth- control rates and types of growth of the organism

LIPID SOLUBLE HORMONES 1. 2. 3. 4. Thyroid and steroid hormones can cross the cell membrane and bind to INTRACELLULAR RECEPTORS in the cytoplasm of the nucleus. The HORMONE-RECEPTOR COMPLEX triggers activation or inactivation of specific genes on the DNA strand Synthesis of new protein by transcription and translation alters the cellular activity causing a physiological response HORMONES THAT UTILIZE THIS METHOD: TESTOSTERONE, ESTROGEN, PROGESTERONE, GLUCOCORTICOIDS, MINERALCORTICOIDS

AMINO-ACID BASED HORMONES (WATER SOLUBLE) 1. CYCLIC AMP SIGNALING MECHANISM a. The hormone binds to a CELL MEMBRANE RECEPTOR which causes the receptor to change shape b. CYCLIC AMP (THE SECOND MESSENGER) acts intracellularly to activate PROTEIN KINASE enzymes that mediate cell responses to hormones. c. EXAMPLES OF HORMONES THAT UTILIZE THIS METHOD: ACTH, FSH, LH, GLUCAGON, PTH, TSH, CALCITONIN, CATACHOLAMINES Negative feedback system- physiological response causes decreased release of hormone (EXAMPLE: the action of INSULIN & GLCAGON) Positive feedback system physiological response causes increased release of the hormone (EXAMPLE: the action of OXYTOCIN)

RESPONSIVENESS OF TARGET CELL IS DEPENDENT ON 3 FACTORS: 1. CONCENTRATINO OF HORMONE

2. 3.

ABUNDANCE OF RECEPTORS INTERACTION OF THE OTHER HORMONES a. PERMISSIVE EFFECT- hormone requires current or recent exposure to another hormone (EXAMPLE: RENIN & ANGIONTENSIN II) b. SYNERGISTIC EFFECT- 2 hormones together cause a stronger response than their individual responses (EXAMPLE: ADH, ALDOSTERONE, EPINEPHRINE, RENIN/ANGIOTENSIN II) c. ANTAGONIST EFFECT- one hormone inhibits the response of another (EXAMPLE: CALCITONIN & PTH)

PITUITARY GLAND (HYPOPHYSIS) Also known as MASTER GLAND Located within SELLA TURCICA of the sphenoid bone Associated closely with the hypothalamus by the INFINDIBULUM Differentiated in anterior pituitary (ADENOHYPOPHYSIS)the posterior pituitary (NEUROHYPOPHYSIS)

POSTERIOR LOBE(NEUROHYPOPHYSIS) Connected with the hypothalamus via the supraopticohypophyeal tract. Does produce secretionstores the secretions produced by the hypothalamus OXYTOCIN- stimulates contraction of smooth muscle of the uterus during pregnancy and initiates labor cycle ANIT-DIURETIC HORMONE (ADH)- controls water reabsorption by the DCT and collection ducts of the kidney nephrons and stimulates smooth muscle of the digestive tract & blood vessels

ANTERIOR LOBE(ADENOHYPOPHYSIS) Controlled by hormones produced by hypothalamus such as TRH and LHRH Called the MASTER GLAND!! GROWTH HORMONE (GH) produced by somatotropic cells of the anterior lobs stimulate most body cells to increase in size and divide (BONES & SKELETAL MUSCLE) THYROID-STIMULATING HORMONE (TSH OR THYROTROPIN) stimulates the thyroid gland to grown and increase secretions of thyroid hormones ADRENOCORTICOTROPIC HORMONE (ACTH OR CORTICOTROPIN) stimulates adrenocortical (adrenal gland) growth and increase secretions of adrenal gland hormones. FOLLICLE- STIMULATING HORMONE (FSH OR GONADOTROPIN) stimulate growth of ovarian follicles in females and spermatozoa in males LUTEINIZING HORMONE(LH) interstitial cell stimulating hormone in males, stimulates ovulation in females and testosterone production in males PROLACTIN (PRL OR LUTEOTROPIC HORMONE) maintains corpus luteum and stimulates milk productions and breast development MELANOCYTE-STIMULATING HORMONE (MSH) stimulates melanocytes which regulate pigments, melanin, or the skin

THYROID GLAND Located in the neck below the larynx and anterior to trachea 2 lobes connected by an isthmus

FOLLICULAR CELLS of the thyroid produce glycoprotein called THYROGLOBULIN AKA COLLOID, which is derivative of most thyroid hormones Hormones synthesized from iodinated thyroglobulin and tyrosine and regulate speed of all basic cellular processes THYROID HORMONE, OR THYROXINE (T4) stimulates growth processes and control metabolic turnover of oxygen TRIIODOTHYRONINE (T3)controls metabolic turnover of oxygen and stimulates growth processes CALCITONIN (CT) polypeptide hormone produced by the C cells of the thyroid gland that lower blood calcium levels by inhibiting osteoclasts and enhancing OSTEOBLASTS and calcium uptake and incorporation into the bone matrix. Produced by PARAFOLLICULAR CELLS! Hormone production regulated by thyroid stimulating hormone produced by pituitary gland

PARATHYROID GLAND 4 tiny glands located on the posterior thyroid Possess CHIEF CELLS that produce the PARATHYROID HORMONE (PTH) which help to regulate calcium blood levels o BONES- activates OSTEOCLASTS causing calcium and phosphate ions to be released in blood o INTESTINE- increases calcium absorption from food o KIDNEYS- promotes activation of vitamin D and increases calcium reabsorption in the nephrons

ADRENAL GLAND Located retroperitoneal and superior to kidney Composed of 2 parts of layers; the outer cortex and inner medulla CORTEX produces steroid hormones from cholesterol (CORTICOSTEROIDS) and is divided into 3 regions o ZONA GLOMERULOSA (OUTER) releases MINERALCORTICOIDS, primarily ALDOSTERONE which controls electrolyte balance in the kidneys o ZONA FASCICULATE (MIDDLE) produces GLUCOCORICOIDS such as CORTISOL & CORTISONE which influence metabolism of glucose, protein, & fat- controlled by ACTH o ZONA RETICULARIS (INNER) produces GONADOCORTICOIDS AKA androgens or adrenal sex hormones, such as TESTOSTERONE which influence masculinization MEDULLA releases hormones when the body is under stress and consists of hormone-producing cells called CHROMAFFIN CELLS EPINEPHRINE-(80%) elevates blood sugar, regulates body during stress or anger, raises BP, heartbeat, and increases sympathetic effects of nervous system NOREPHINEPHRINE-(20%)helps maintain BP

THYMUS GLAND Located posterior to the sternum b/t lungs (mediastinum) Large in infant, increases in size until puberty and then shrinks as continue to age Major hormonal product of thymus gland is THYMOSIN which Is essential for normal development of T lymphocytes and the immune response

PINEAL GLAND

Located in the roof of the 3rd ventricle of the brain Composed of secretory cells called PINEALOCYTES The major product is MELATONIN whose concentrations rise and fall in diurnal cycle

PANCREAS Located posterior and inferior to the stomach Considered both endocrine and exocrine ISLETS OF LANGERHANS o ALPHA CELLS- produce GLUCAGON which breaks down glycogen to glucose, synthesizes glucose from lactic acid and other non- carbs molecules, and release glucose to the blood by liver cells. Controls GLUCONEOGENESIS AND GLYCOGENOLYSIS o BETA CELLS- produces INSULIN which lowers blood glucose levels by enhancing membrane transport of glucose into body cells and stimulates GLYCOLYSIS, GLYCOGENESIS, AND LIPOGENESIS o DELTA CELLS- produces SOMATOSTATIN which inhibits insulin and glucagon ACINAR CELLS- produce PANCREATIC ENZYMES which are exocrine secretions that travel via ducts to small intestines

OVARIES Located in pelvic cavity. Produces ESTROGEN which regulates secondary sex characteristics Also produce PROGESTERONE which helps to stimulate the uterus to bring about thickening and vascularization of endometrium in prep for implantation of a fertilized egg

TESTES Located in scrotum. Secretes TESTOSTERONE, the male sex hormone, which brings about development of secondary sex characteristics, normal sex behaviors, and product of sperm Also produces INHIBIN which inhibits the release of FSH & GnRH when sperm counts high

PLACENTA Temporary organ only formed during pregnancy; produces hCG hormone (humanchrioic gonadotrophic) with aid in maintaining pregnancy and keeping corpus luteum intact

HEART Secretes ANP that literally means producing salty urine & inhibits aldosterone release by adrenal cortex

KIDNEY- secretes ERYTHROPOIETIN for red blood cell production SKIN- produces CHOLEOCLACIFEROL, the inactive form of vitamin D ADIPOSE TISSUE- releases LEPTIN following uptake of glucose and lipids resulting in satiety GASTROINTERTINAL TRACT- possesses cells that produce SEROTONIN, SECRETIN, GASTRIN, & CHOLECYSTOKININ

HOMEOSTATIC IMBALANCES OF ENDOCRINE SYSTEM: 1. 2. 3. 4. 5. 6. 7. Gigantism- hypersecretion of GH is children Acromegaly- hypersecretion of GH in adults Progeria- severe hyposecreton of GH where body tissues being atrophy causing premature aging Pituitary dwarfism- hyposecretion of GH in children resulting in slow bone growth Galactorrhea- inappropriate lactation due to hypersecretion of prolactin Gynecomastia- breast enlargement Myxedema- hypothyroid syndrome resulting in low metabolic rate, feeling chilled, constipation, thick drink skin, puffy eyes, edema a. Goiter- when myxedema results from lack of iodine b. Cretinism- severe hypothyroidism Graves disease- hyperthyroidism resulting in elevated metabolic rates, sweating, protrusion of eyeballs (EXOPHTHALAMOS) rapid, irregular heartbeat, nervousness, etc Hyperparathyroidism- resulting in calcium being leached from the bones Hypoparathyroidism- results in low calcium levels and increases excitability of neurons. Diabetes insipidus- deficiency of ADH secretion causing increase in urine output (dehydration) Aldosteronism- (AKA CONNS DISEASE) hypersecretion of aldosterone resulting in hypertension and edema as well as accelerated excretion of potassium ions Addisons disease- hyposecretory disease of adrenal cortex resulting in excess potassium in blood Cushings disease- increase in secretion of ACTH due to ACTH-releasing tumor of the pituitary or by high doses of glucocorticoids drugs; results in reduction of blood potassium level MOON FACE Masculinization or virilization- hypersecretion of gonadocorticoids Diabetes mellitus a. Type I- before age 20 from loss of beta cells of pancreas resulting in insulin depencence b. Type II- over age 40 from target cells inability to use insulin; individual is said to be noninsulin dependent Hirsutism- excessive hair growth (usually occurring in women)

8. 9. 10. 11. 12. 13. 14. 15. 16.

17.

THE URINARY SYSTEM FUNCTIONS OF EXCRETORY SYSTEM: Regulates volume, composition, and pH of body fluids Excretes metabolic wastes Regulates BP, RBC production, synthesizes calictrol (AKA vitamin D) performs gluconeogenesis

GROSS ANATOMY 2 bean shaped KIDNEYS filter blood to remove metabolic wastes, ions, hormones etc 2 URETERS that drain urine away from kidneys and formed as continuation of renal pelvis. Made of 3 layers (mucosa, muscularis, adventitia) peristalsis and gravity transport urine to bladder for storage URINARY BLADDER serves as storage area until MICTURTION occurs. Composed of smooth muscle and TRANSITIONAL EPITHELIAL TISSUE so that bladder can stretch when full and go back to original shape when empty. Possesses RUGAE and a TRIGONE. DESTRUSOR MUSCLE contracts=urgency URETHRA drains urine from urinary bladder and transports the urine to the outside. Lined with PSEUDOSTRATIFIED COLUMNAR EPITHELIUM. In females, urethra only drains urine. In males, drains urine and semem and is divided into to PROSTATIC URETHRA, MEMBRANOUS URETHRA, AND SPONGY URETHRA. Possess and INTERNAL URETHRAL SPHINCTER (smooth muscle) AND EXTERNAL URETHRAL SPHINCTER (skeletal muscle)

KIDNEY ANATOMY Kidneys located retroperitoneally on each side of vertebral column b/t 12 thoracic vertebrae and 3 rd lumbar vertebra RIGHT KIDNEY LOWER than left one because liver size and position RENAL HILUS- notch where blood vessels, nerves, lymphatic vessels enter and exit kidney Connective tissue layers: o Renal capsule- adheres directly to the kidney surface o Adipose capsule- middle layer of fatty tissue that insulates and cushions kidneys o Renal fascia- outermost dense connective tissue that anchors kidney to adrenal glands RENAL CORTEX- out most portion of the kidney which is light in color and has granular appearance RENAL MEDULLA- MIDDLE, next deep layer that possess many cone shaped masses=renal pyramids RENAL COULUMNS- INWARD extensions of cortical tissue that separates the pyramids RENAL PELVIS- flat funned shaped tube drains urine from cortex and medulla towards ureters CALYCES- major/minor branches of renal pelvis that enclose the tops of renal pyramids

BLOOD SUPPLY RENAL ARTERIES- bring oxygenated unfiltered blood into the kidney. Renal arteries branch into smaller and smaller vessels in the following order SEGMENTAL ARTERIES, LOBAR ARTERIES, INTERLOBAR ARTERIES, ARCUATE ARTERIES, CORTICAL RADIATE ARTERIES, AFFERENT ARTERIOLES, GLOMERULAR CAPILLARIES (FIRST CAPILLARY BED) EFFERENT ARTERIOLES, PERITUBULAR/VAS RECTA CAPILLARIES (SECOND CAPILLARY BED) The PERITUBULAR CAPILLARY BEDS transport blood to the veins in processed deoxygenated form in following sequence:

CORTICAL RADIATE VEINS, ARCUATE VEINS, INTERLOBAR VEINS, INTERLOBAR VEINS, RENAL VEIN, INFERIOR VENA CAVA

FUNCTIONAL UNIT OF KIDNEY=NEPHRON There are over 1 million nephrons per kidney which do no regenerate. A person can survive as long as at least 25% of nephrons are functional RENAL CORPUSCLE: GLOMERULUS- first capillary bed made of FENESTRATED CAPILLARIES which are porous allowing large amounts of solute to pass from blood and into surround bowmans capsule. Substance removed from blood is FILTRATE. BOWMANS CAPSULE- first collection tubule that surrounds glomerulus and is primarily SIMPLE SQUAMOUS, basement membrane, associated with specialized branching cells called PODOCYTES JUXTAGLOMERULAR CELLS- smooth muscle cells that act as mechanoreceptors that sense BP in afferent arteriole. JG cells secrete RENIN in response to LOW BP. MACULA DENSA CELLS- osmoreceptors that respond to solute concentrations in the filtrate and filtrate flow. LOW OSMOLARITY (slow flow)= STIMULATES VASODILATION. HIGH OSMALARITY (fast flow) STIMULATES VASONCONSTRICTION MESANGIAL CELLS- possess PHAGOCYTIC and CONTACTILE abilities to influence total surface area available for filtration, PCT- with walls of BRUSH BORDER CUBOIDAL EPITHELIUM for absorption and secretion are located in renal cortex. LOOP OF HENLE- with ascending and descending ends and a thick segment of CUBOIDAL AND LOW COLUMNAR AND THIN SEGMENT OF SIMPLE SQUAMOUS located in medulla DCT- with walls of NON CILIATED CUBOIDAL EPITHELIUM are more involved in secretion CORTICAL NEPHRONS(85%) located almost entirely in cortex JG NEPHRONS- have loops of henle that deeply invade medulla. Associated with VASA RECTA and production of concentrated urine.

PRODUCTION OF URINE INVOLVES: GLOMERULAR NON-SELCECTIVE FILTRATION occurs at glomerulus and bowmans capsule TUBULAR REABSORPTION occurs in the PCT, loop of henle, and first part of DCT TUBULAR SECRETION occurs mostly in the PCT with exception of K+ in DCT

NON SELECTIVE FILTRATION Unfiltered blood in afferent arterioles enter glomerulus Recall NET FILTRATION PRESSUE. Hydrostatic pressure high inside glomerulus, filtrate forced out of the blood plasma and into bowmans capsule Most is (except blood cells and plasma proteins) is forced into bowmans capsule as filtrate EFFERENT ARTERIOLES transport filtered blood away from the glomerulus towards capillary bed Glomerulus is unique capillary bed b/c arterioles move blood into capillary bed and transport blood away from the capillary bed! Almost all other capillary beds in the body have venules taking blood away from capillary bed! GLOMERULAR FILTRATION RATE(GFR) amount of filtrate formed in both kidneys per minute. Healthy individual=1200ml or blood enters nephron per minute. As result of high hydrostatic pressure in glomerulus, glomuruli produce 125ml of filtrate per minute. The majority (124ml) is

reabsorbed in renal tubule portion of nephron. Only about 1ml of urine is produced for each 125ml of glomerular filtrate. THE HYDROSTATIC PRESSURE in a typical glomeruli (55mmHg) is much higher than that of other capillary beds (15-18 mmHg). This results in more filtrate being produced by glomeruli (180 L per day) compared to other total so most filtrate produced by glomeruli is immediately reabsorbed in renal tubules.

TUBULAR REABSORPTION As glomerular filtrate enters PCT, the loop off henle, and first part of DCT, water, ions and other substances are reabsorbed into the blood via second capillary bed called PERITUBULARY BED Na+ is moved out of the tubule and into the blood by PRIMARY ACTIVE TRANSPORT and later simple diffusion whereas glucose, amino acids, lactic acid, vitamins, and most cations are reabsorbed by SECONDARY ACTIVE TRANSPORT. Some substances (cations like K+ and anions like Cl-) move through intercellular spaces to leave the tubules to the interstitial spaces and then diffuse into blood Most other substances (UREA, FAT-SOLUBLE VITAMINS) diffuse from tubule lumen directly into capillary bed. TRANCELLULAR & PARACELLULAR movements are utilized. Trancellular means substances pass THROUGH the tubular cells while paracellular means the substances pass BETWEEN tubular cells despite numerous tight junctions. 99% of all filtrate is reabsorbed. out 180 L of filtrate produced per day, only 1.5 L or urine produced 100% of filtered nutrients (glucose, amino acids, vitamins) reabsorbed in PCT 80% of filtered BICARBONATE(HCO3-) reabsorbed in PCT 65%of filtered H2O reabsorbed in PCT 65% of filtered Na+ is reabsorbed in PCT 60% of filtered Cl- is reabsorbed in PCT 55% of filtered K+ is reabsorbed in PCT. Most reabsorption occurs in PCT. As filtrate enters loop of henle, water reabsorption continues on descending portion while solute reabsorption (particularly Na+) occurs in ascending portion. WATER FOLLOWS Na+ while K+ always moves opposite to Na+ movement (when Na+ reabsorbed, water is reabsorbed and potassium is secreted)

TUBULAR SECRETION The remaining fluid that enters the rest of the DCT is not complete. Only 25% of filtered water and 10% of filtered NaCl remains in the tubules Tubular secretion involves the movement of substances out of blood (PERITUBULAR CAPILLARY BED) and into remaining filtrate Some substances move by ACTIVE TRANSPORT while others move by PASSIVE TRANSPORT Substances commonly secreted include POTASSIUM IONS, HYDROGEN IONS, BICARBONATE IONS, AMMONIA IONS, BY PRODUCTS OF DRUGS AND METABOLITES, CREATININE, AND SOME HORMONES (hCG) The final fluid that now drain into the RENAL PELVIS (MINOR AND MAJOR CALYCES) which connects to the tops of each ureter. Peristalsis in the ureters transports urine to the bladder for storage.

COUNTERCURRENT MECHANISM- used to create highly concentrated urine

COUNTERCURRENT MULTIPLIER- the long loops of henle of the JG nephrons create the medullary osmotic gradient. o o The descending limb of the loop of henle is permeable to water and impermeable to NaCl The ascending limb of the loop of henle is permeable to NaCl and impermeable to water

COUNTERCURRENT EXACHANGE- the vasa recta preserves the medullary gradient while removing reabsorbed water and solutes. o o The vasa recta is highly permeable to both water and solutes Blood becomes more concentrated as it descends deeper into the medulla and less concentrated as it approaches the cortex

SUBSTANCES THAT ARE NOT REABSORBED EASILY AND THEREFORE SHOW UP READILY IN URINE UREA, URIC ACID, & CREATININE (SECRETED RATHER THAN FILTERED)

URINE COMPOSITION 90% water, METABOLIC OR NITROGENOUS WASTES (urea, creatinine, uric acid), SALTS, TOXINS, PIGMENTS SUCH AS UROCHROME (breakdown of hemoglobin and bile pigments), HORMONES, IF BLOOD , PROTEIN, OR GLUCOSE ARE DETECTED IN URINE THIS IS USALLY AN INDICATION OF KIDNEY TROUBLES.

URINE CHARACTERISTICS COLOR- clear of transparent with a deep yellow color due to urochrome pigment. Certain foods can affect color of urine (BEETS) ODOR- slightly aromatic when fresh but tens to develop ammonia odor due to bacterial metabolism. Some goods affect odor (ASPARAGUS) pH- urine is slightly acidic (about pH 6). Homeostatic range is 4.5-8.0. SPECIFIC GRAVITY- measure of how concentrated urine is 1.005-1.035

HORMONES ASSOCIATED WITH KIDNEY ANTIDIURETIC HORMONE(ADH)- plays a role in WATER REABSORPTION at the COLLECTING DUCTS. Increased ADH=INCREASE WATER ABSORPTION which in turn means less urine produced. The INCREASE IN WATER RETENTION CAUSES AND INCREASE IN BLOOD VOLUME which cause BP to INCREASE. ALSODTERONE- promotes reabsorption of SODIUM IONS (Na+) and the secretion of POTASSIUM IONS (K+) within RENAL TUBULES. For example: low sodium concentration causes suprarenal cortex to increase secretion of aldosterone. This excites tubular cells resulting in sodium transport into capillaries. Because water follows sodium, water reabsorption occurs which causes BLOOD PRESSURE TO RISE. ATRIAL NATRIURETIC PEPTIDE (ANP)peptide that INHIBITS SECRETION OF ALDOSTERONE therefore promoting the excretion of Na+ and ultimately the reabsorption of K+. WATER FOLLOWS SODIUM, so if sodium excreted, more eater will be lost via urine. ANP ACTS AS A DIURETIC. RENIN & ANGIOTENSIN II- rennin release triggered by DROP IN BP causing ANGIOTENSIN II(POTENT VASOCONSTRICTOR) angiotensin II decreases glomerular filtration rate which in turn RAISES BLOOD VOLUME WHICH RAISES BP

Chronic alcoholic patients may experience low blood concentrations of key electrolytes as well as potentially severe alterations in the bodys acid-base balance. In addition, alcohol can disrupt the hormonal control mechanisms that govern kidney function. By promoting liver disease, chronic drinking has further detrimental effects on the kidneys, including impaired sodium and fluid handling and even acute kidney failure. HOMEOSTATIC IMBALANCES OF URINARY SYSTEM PTOSIS- kidneys drop in position resulting in kinked ureters HYDRONEPHROSIS- fluid building up in the kidney and renal pelvis because of ptosis. PYELITIS- infection of the renal pelvis and calyces PYELONEPHRITIS- infection or inflammation of the entire kidney. ANURIA- low urinary output as a result or injury. Transfusion reactions, low BP etc HYPERURIA- excess urine output HYPOSPADIAS- urethral orifice is located on the ventral surface of the penis DIABETES INSIPIDUS- production of large quantities of urine resulting in dehydration and intense thirst. Occurs as result of low ADH release RENAL CALCULI- kidney stones URETHRITIS- inflammation on the urethra CYSTITIS- inflammation of the bladder CYSTOCELE- herniation of the urinary bladder into the vagina INCONTINENCE- inability to control micturion URINARY RETENTION- inability to expel urine HOSESHOE KIDNEY- developmental disorder resulting in the 2 kidneys being very close together or joined ( 1 in 600 people) POLYCYSTIC KIDNEY- an inherited condition that results in urine-filled cysts (or a chloride-rich fluid) forming within the kidney RENAL INFARCT- area of dead, or necrotic, renal tissue

FLUID AND ELECTROLYTE BALANCE Water is the largest single component of the body Total body water is a function not only of weight, age, and se but also relative amount of body fat Since fat is free of water (HYDROPHOBIC), the less fat present corresponds to greater % body weight due to water EARLY EMBRYO; 97% NEWBORN INFANT: 77% ADULT MALE: 60% ADULT FEMALE:54% ELDERLY ADULT: 45% Adipose tissue is 20% hydrated while skeletal muscle is 65% water

FLUID COMPARTMENTS INTRACELLULAR FLUID COMPARTMENT (ICF)- fluid within each cell (25L) EXTRACELLULAR FLUID COMPARTMENT (ECF)- 15L of body water is found outside of cells and is divided into 2 subcompartments INTRAVASCULAR- fluid portion of blood within blood vessels INTERSTITIAL FLUID- fluid in microscopic space between cells OTHER- lymph, cerebrospinal fluid, humors of eyes, synovial fluid, serous fluid, secretions of GI trac

ELECTROLYTES- molecules that ionize (dissociate to form charged particles called ions) in a solution rendering the solution capable of conducting electrical current. EXAMPLES= SALTS, ACIDS, AND BASES -CATIONS- an ion carrying a positive charge = (Na+, H+, K+, Ca2+, Mg2+) -ANIONS- an ion carrying a negative charge = (Cl-, HCO3-, HPO42-, SO42-) NON-ELECTROLYTES- molecules that have bonds that prevent them from dissociating in solution (GLUCOSE, LIPIDS, CRATININE, UREA) -Electrolyte concentrations usually expressed in milliquivalents per liter (mEq/L) -Blood plasma and interstitial fluids are very similar except that PROTEIN LEVELS ARE HIGHER IN BLOOD because they are too large to diffuse into and out of capillary vessels -Blood plasma and interstitial fluids (extracellular) have increased Na+ cations & increased Cl-anions -INTRACELLULAR FLUIDS have increased K+cations and increased HPO42- anions -SOIDUM AND POTASSIUM ion concentrations in extracellular and intracellular fluids are nearly opposite and is likely explained by the SODIUM POTASSIUM PUMP that help to maintain ion distributions - NON ELECTROLYTES account for 90% of solutes in PLASMA, 60% SOLUTES IN INTERSTITIAL FLUIDS, AND 97% OF SOLUTES IN INTRACELLULAR COMPARTMENTS ARE NON ELECTROLYTE MATERIALS FLUID MOVEMENT AMONG COMPARTMENTS Blood plasma circulate throughout the body and links the external and internal environments as well as the ICF & ECF

INCREASED HYDROSTATIC PRESSURE at the arteriole end of the capillary bed forces fluid and substances out of the blood vessels into the interstitial space INCREASED COLLOID OSMOTIC PRESSURE of the venous end of the capillary bed (due to impassable plasma proteins) creates a SUCTION of fluids into the blood vessel and out of the interstitial spaces Movements from interstitial spaces to intracellular compartments are more complex because of SELEVTIVE PERMEABILITY OF MEMBRANES Water flows freely in and out as a response to concentration gradients Ions fluxes are achieved by ACTIVE TRANSPORT Movements of nutrients, respiratory gases, and wastes are unidirectional NUTRIENTS AND OXYGEN move into cells METABOLIC WASTES AND CARBON DIOXIDE move out of cells

WATER BALANCE To remain properly hydrated, water intake (2500ml) must be equal to water output (2500ml) Major source of water intake: LIQUIDS(60%) SOLID FOODS (30%) METABOLIC WATER (10%) MAJOR SOURCES OF WATER OUTFPUT: o INSENSIBLE LOSSES- LUNGS AND SKIN (28%) o SENSIBLE LOSSES- SWEAT(8%) URINE(60%) FECES(4%)

REGULATION OF WATER INTAKE: the thirst mechanism Increased plasma osmolarity (high solutes) or decreased plasma volume triggers the thirst mechanism, which is mediated by BYPOTHALMIC OSMORECEPTORS. When osmoreceptors lose water by osmosis to a hypertonic ECF, the hypothalamic thirst center is stimulated motivating the individual to drink Thirst, inhibited by distention of GI tract by ingested water and then by osmotic signals, may be dampened before the body needs for water have been met

REGULATION OF WATER OUTPUT OBLIGATORY WATER LOSSES INCULDE SENSIBLE AND INSENSIBLE WATER LOSSES THAT ARE UNAVOIDABLE AND NECESSARY FOR SURVIVAL Obligatory water losses reflect that when we eat and adequate diet, our kidneys must excrete solutes to maintain blood homeostasis and HUMAN KIDNEYS much flush urine solutes out of the body in water. Beyond obligatory water loss, the solute concentrations and volume of urine excreted depend on fluid intake, diet, and water loss via other avenues

DISORDERS ASSOCIATED WITH LOSS OF WATER BALANCE DEHYDRATION- water loss exceeds water intake over a period of time and the body is in negative fluid balance EXAMPLES: HEMORRHAGE, SEVERE BURNS, VOMITING AND DIARRHEA, PROFUSE SWEATING, WATER DEPRIVATION, AND DIURETIC ABUSE. HYPOTONIC HYDRATION- excessive water build up in the cells causing them to swell. Particularly damaging to neurons which can lead to disorientation, convulsions, coma, and death. EXAMPLES: Excessive water intake in a short period of time & renal insufficiency EDEMA- accumulation of fluid in the interstitial spaces leading to tissue swelling.

EXAMPLES: excess fluid loss from the blood and into the interstitial spaces includes INCREASED BLOOD PRESSURE AND CAPILLARY PERMEABILITY. Blockage of the lymphatic vessels and low plasma proteins as a result of glomerulonephritis, malnutrition, or liver disease results in fluid being unable to leave the interstitial spaces and enter the bloodstream

ELECTROLYTE BALANCE The central roles of sodium in fluid and electrolyte balance: Most electrolytes, or salts are obtained from ingested foods and fluids. Salts, particularly NaCl are often ingested in excess of need. Electrolytes are lost in perspiration, feces, and urine. Kidneys are most important in regulating electrolyte balance Sodium salts are the most abundant solutes in ECF. They exert bulk of ECF osmotic pressure and control water volume and distribution in the body. WATER FOLLOWS SALT Na+ transport by renal tubule cells in couples to and helps regulate K+, Cl-, HCO3+, and H+ concentrations in the ECF

REGULATION OF SOIDUM BALANCE INFLUENCE AND REGULATION OF ALDOSTERONE: When aldosterone concentrations are high, virtually all the Na+ ions are reabsorbed and water follows it (ESPECIALLY IF ADH IS HIGH) aldosterone simultaneously encourages K+ secretion into the renal tubules If aldosterone release is inhibited, essentially no Na+ reabsorbtion occurs and it is instead EXCRETED IN DILUTE URINE