FISIOLOGI

SISTEM UROPOETIKA

SISTEM UROPOITIKA /
URINARIUS
TERDIRI DARI : GINJAL, URETER, VESIKA URINARIA DAN
URETHRA

FUNGSI GINJAL:

1. EKSRESI:
2.
3.
4.

AIR, UREA, AS. -URAT, KREATININ, PO4,

Na+, K+, H+ , OBAT2, DLL.
EGULASI: MENGATUR KESEIM. ASAM-BASA, AIR DAN
ELEKTROLIT, MENGATUR TEKANAN DARAH / VOL.
PLASMA
HORMONAL: ERITROPOIETIN, RENIN,
BRADIKININ
DAN
KALIKREIN
METABOLISME: MENGAKTIFKAN VIT.D D3
SISTESIS GLUKOSA SAAT PUASA

GINJAL

ANATOMI SISTEM URINARI

REN
Ukuran: panjang : 12-13 cm (sinister lebih panjang)
berat

: 130-250 gr (laki)
90-220 gr (wanita)

Letak:

Retroperitoneal
Posisi anatomis: Th12 - L3
Sinus renalis:
Hilus renalis:
Vasa renalis (cabang2 nya)
Pelvis renalis (cabang2nya)
Vasa limphacea
Serat saraf
Jaringan ikat

REN
Pelvis renalis:

2-3 calyces majores

7-14 calyces minores

Struktur:

nephron: unit fungsional ren

Terdiri dari:

Corpuscula renalis (capsula glomerulus &

glomerulus)
Tubulus contortus proximalis
Loop dari Henle
Tubulus contortus distalis

Secara longitudinal:
Cortex renalis
Medulla renalis

GINJAL

KAPILER GLOM + KAPSULA BOWMAN

DISEBUT: KORPUSKULUM RENALIS (BADAN
MALPHIGI)

NEFRON: UNIT FUNGSIONAL DARI

GINJAL
TERDIRI

DARI:
- KAPILER GLOMERULUS
- TUBULUS
* Kapsula Bowman

*
*
*
*
*

TCP
Ansa Henle
TCD
Tub. Kolektivus
Duktus kolektivus

IHTISAR FUNGSI GINJAL

ADA 3 PROSES DI NEFRON DALAM
PEMBENTUKAN KEMIH/ URINE

1. FILTRASI GLOMERULUS .
2. REABSORPSI TUBULUS
3. SEKRESI SEL TUBULUS

FILTRASI, REABSORPSI DAN

SEKRESI

EKSRESI

TEKANAN FILTRASI NETO.

GLOMERULO FILTRATION RATE (GFR)

ATAU LAJU FILTRASI GLOMERULUS
JUMLAH VOL. PLASMA YANG DI FILTRASI KE KAPSULA BOWMAN
PER
SATUAN WAKTU (MENIT).

SIFAT MEMBRAN GLOM. UNTUK MELEWATKAN PLASMA

DISEBUT:
KOEFISIEN FILTRASI (KF)

GFR = KF x TEK. FILT. NETO

KF DIPENGARUHI OLEH PERMIABILITAS MEMB. GLOM.

PERMIABILITAS MEMB. GLOM. DIPENGARUHI OLEH:

- LUAS PERMUKAAN MEMB. GLOM.
- TEBAL MEMB. GLOM.

 25 % DARI COP MENUJU GINJAL

PRIA DEWASA BB 70 KG, JUMLAH

DARAH 5 LITER
VOL. PLASMA CUMA 3 LITER
GFR : 125
ML/MENIT ( 115 ml
WANITA) ATAU 180 L/HARI
JADI PLASMA DI PROSES OLEH GINJAL
180 L/hari/3 L = 60 KALI/HARI

URINE YANG TERBENTUK HANYA 1

1,5 LITER/HARI
99% LEBIH FILTRAT
KEMBALI

DI REABSORPSI

FRAKSI FILTRASI (FF) JUMLAH PLASMA YANG

MELALUI GINJAL YG DI FILTRASI KE KAPSULA
BOWMAN BESARNYA ADALAH 20 %.
GFR
FF = ------RPF

----->

GFR
RPF = -----FF

125 ml/ MENIT

-----------------0,2

625 ml/menit

RBF = RPF + BUTIR-BUTIR DARAH

= 1200 mL / MENIT

FRAKSI FILTRASI (FF)

TEKANAN DARAH DAN ALIRAN DARAH

GINJAL MEMPENGARUHI GFR

2. REABSORPSI TUBULUS
-BERSIFAT SELEKTIF
_ REABSORPSI AKTIF:
PRIMER
: Na +
SEKUNDER : MENGIKUTI Na+ SEPERTI
GLUKOSA, AA, ION DAN

MACAM-MACAM METAB.

ORGANIK
_ REABSORPSI PASIF: UREA

Figure 18-11

Figure 18-12

3. SEKRESI SEL TUBULUS

TRANSFER MOL. DARI KAP. PERI

TUBULER KE LUMEN TUBULUS

MISAL: K+, H+ DLL.

CLEARANCE
CLEARANCE (C) : DAPAT UNTUK MENGUKUR

GFR.
CLEARANCE SUATU ZAT :
BANYAKNYA PLASMA YANG MELALUI GINJAL
YANG DIBERSIHKAN DARI SUATU ZAT TSB.
DALAM SATUAN WAKTU (MENIT)

UXV
C =------P

C = Clearance
U = Konsentrasi zat dalam urine
V = Kecepatan aliran urine
P = Konsentrasi zat dalam plasma
CxP=UxV

MIKSI (PEMBUANGAN URIN)

Refleks berkemih adalah suatu

siklus tunggal lengkap, yaitu :

1. Peningkatan tekanan yang cepat dan

progresif
2. Periode tekanan dipertahankan
3. Kembalinya tekanan ke tonus basal
kandung kemih

Apabila kandung kemih menjadi

semakin terisi, refleks berkemih
menjadi semakin sering dan semakin
kuat.

Refleks miksi adalah refleks MS yang

bersifat autonomik, tetapi dapat
dihambat atau dirangsang oleh pusat
dalam otak (pons dan korteks serebral)

1. Pusat yg lebih tinggi dpt mencegah

2.

berkemih dg membuat kontraksi tonik

terus-menerus pd sfingter eksternus sampai
mendapatkan waktu yg baik untuk
berkemih.
Jika tiba waktu untuk berkemih, pusat
kortikal dapat merangsang pusat berkemih
sakral utk membantu mencetuskan refleks
berkemih dan dlm waktu bersamaan
menghambat sfingter eksternus shg

KESEIMBANGAN CAIRAN DAN

ELEKTROLIT
HOMEOSTASIS CAIRAN DAN ELEKTROLIT
TUBUH KITA TERUS MENERUS BERUBAH
SEHARI MASUK 2 L MAKANAN DAN MINUMAN
DENGAN 6 15 GRAM NaCL + ELEKTROLIT K+,
H+, Ca++, HCO3-& PO4-2
KEGIATAN TUBUH MENJAGA KESEIMBANGAN
MASA TUBUH, DENGAN MEMBUANG ZAT2 YG TAK
DIPERLUKAN.
ORGAN EKSRESI SELAIN GINJAL: GIT, KULIT DAN
PARU YG MEMBUANG H+ DAN HCO3 DGN EKSRESI
CO2.
PENGATURAN LAIN MELALUI RASA HAUS,
KEINGINAN THD GARAM

OSMOLARITAS CES
MEMPENGARUHI VOL. SEL
OSMOLARITAS RASIO ZAT TERLARUT
TERHADAP PELARUTNYA

KESEIMBANGAN AIR DAN ELEKTROLIT PERLUINTEGRASI BANYAK SISTEM

KESEIMBANGAN AIR DAN PENGATURAN

KONSENTRASI URIN

SEBAGIAN BESAR TUBUH TERDIRI DARI AIR.

LAKI2 60% AIR DAN PEREMPUAN 50% AIR.(DEWASA)
LAKI BB 70 KG, 42 L AIR TDD:

28 L C I S

3 L PLASMA

14 L CES

11 L C I

CAIRAN MASUK DAN KELUAR SETIAP HARI

SEIMBANG

GINJAL MENGHEMAT PENGELUARAN AIR

KONSENTRASI URIN DITENTUKAN OLEH

LOOP HENLE DAN DUKTUS PENGUMPUL

ADH (ANTI DIURETIC HORMON) ATAU VASOPRESSIN

MENGATUR OSMOLARITAS URIN

 Bila osmolaritas cairan tubuh

meningkat,maka sekresi ADH akan
meningkat yang menyebabkan
peningkatan permeabilitas tub.distal dan
duktus koligentes thd.air,shg.reabsorpsi
air meningkat. Hasil akhirnya volume urin
berkurang sehingga urin menjadi lebih
pekat (demikian sebaliknya)

Jadi ada atau tidaknya ADH menentukan

apakah ginjal mengeluarkan urin encer

atau pekat.
Ginjal manusia dpt.memproduksi urin
pekat max.1200-1400 mOsm/L

PERUBAHAN TEKANAN DARAH DAN OSMOLARITAS

SEBAGAI PENCETUS REFLEKS KESEIMBANGAN AIR

KESEIMBANGAN Na+ DAN PENGATURAN VOL.

CES

ALDOSTERON MENGONTROL KESEIMBANGAN Na+

 TEKANAN DARAH, OSMOLARITAS DAN K+,

MEMPENGARUHI SEKRESI ALDOSTERON

ALDOSTERON

 NATRIAL NATRIURETIC PEPTIDE MENYEBABKAN

EKSRESI Na+ DAN AIR

KONTROL TERINTEGRASI THD. VOL. DAN OSMOLARITAS

OSMOLARITAS DAN CES DAPAT MENGATASI KETER

GANTUNGAN

Proses pembentukan urin

Proses pembetukan urine

1. Filtrasi Glomerular
2. Reabsorbsi Tubular
3.

darah
Sekresi tubular
cairan lumen tubulus

Keseimbangan
jumlah yang dieksresi
dalam urine = jumlah yang
difiltrasi oleh glomerulus
jumlah yang direabsorbsi
ke dalam kapiler + jumlah
sekresi tubulus

Ekskresi :
semua hasil filtrasi dan sekresi yang tidak terabsorbsi

Ion yang berlebihan, H2O, toksin, urea, molekul asing

(obat, dll)
Kidney Ureter bladder urethra out of body

Komposisi filtrat
glomerulus
Komposisi Filtrat glomerulus = konsentrsi
plasma darah (konsentrasi garam dan
molekul organik : glukosa, asam amino)
kecuali protein (bebas protein)

Filtrasi glomerulus dibatasi oleh besar molekul

dan muatan molekul

Zat terlarut netral :

Zat dengan radius < 180 nanometer difiltrasi secara

bebas
Zat > 360 nm tidak dapat difiltrasi
Zat antara 180 dan 360 nm mengalami difiltrasi (jumlah
tertentu)

Reabsorpsi dan sekresi

Melalui difusi, osmosis, transport aktiv dan
terfasilitasi
Protein pembawa (Carrier proteins) mempunyai

kapasitas transport maksimal (transport maximum

(Tm)) menentukan batas kapasitas tubulus renal
untuk mengabsorbsi suatu bahan terlarut dalam
cairan tubulus (ultrafiltrat).

Suatu transport maximum (Tm):

Menggambarkan jumlah protein pembawa di tubulus yang
tersedia

Reabsorbsi Na+ : terutama melalui

transport aktif

Reabsorbsi pompa
Na+-K+ ATPase

Reabsorbsi Na

menyediakan energi
yang berperan pada
penyerana senyawa
terlarut lain dalam
bakal urin :
H2O melalui osmosis
Nutrisi organik dan
beberapa kation
transport akitif
sekunder (coupled /
co transport

Na+/K+ Pump Active Transport

Figure25.12

Transport aktif sekunder Cotransport

Na+ linked secondary

active transport

Tempat utama TCP

Pada Reabsorbsi :
Glucose
Ion
Asam Amino
Sodium-linkedglucosereabsorptioninthe
proximaltubule

Reabsorption: Transport Maximum

Glucosehandlingbythenephron

Senyawa yang tidak dapat

direabsorbsi
Penyebab: :
Protein pembawa minimal (tidak ada)
Tidak larut lemak
Ukuran terlalu besar untuk melewati
pori pada tubulus

kreatinin dan asam urat senyawa

yang tak terabsorbsi yang paling
bermanfaat untuk evaluasi fungsi
ginjal

Sekresi Tubulus
Penting untuk : :
Membuang senyawa yang tidak bisa
difiltrasi karena kapasitas filtrasi yang
terbatas, misalnya kelebihan ion K
Mebuang senyawa yang tidak dapat
dibuang melali filtrasi karena ukuran
yang besar atau bermuatan kreatinin,
urea dll
Mengontrol pH tubuh

Reabsorbsi dan Sekresi pada TCP

TCP mereabsobsi 60-70% dari hasil filtrasi
glomerulus
Sodium, semua nutrient, kation, anion
(HCO3-), dan H2O
Senyawa larut lipid
Protein dengan ukuran kecil

Mensekresi ion H+

Aktivitas transport pada TCP

Figure26.12

Reabsorbsi dan Sekresi pada

TCD
CTD menentukan komposisi akhir urin
Melakukan Sekresi dan reabsobsi aktif :
Absorbsi Na+ dan Cl Sekresi K+ dan H+ mengontrol pH
darah

Reabsorbsi H2O dikontrol oleh ADH

(vasopressin)

Reabsobsi Na+, K+ dikontrol oleh

aldosterone

Tubular Secretion and Solute

Reabsorption at the DCT

Figure26.14

3 Processes of the DCT

1. Active secretion of ions, acids, drugs,
and toxins
2. Selective reabsorption of sodium and
calcium ions from tubular fluid
3. Selective reabsorption of water:
concentrates tubular fluid

The Collecting System

The distal
convoluted
tubule:
opens into the
collecting
system
Individual
nephrons:
drain into a nearby collecting
duct

Several collecting ducts:

converge into a larger
papillary duct
which empties into a minor
calyx

 Transports
tubular fluid from
nephron to renal
pelvis

Adjusts fluid
composition

Determines final
osmotic
concentration
and volume of

Mechanism of ADH (Vasopressin) Action: Formation of

Water Pores

ADH-dependent water reabsorption is called

facultative water reabsorption

Figure20-6:Themechanismofactionofvasopressin

Effects of ADH on the DCT and

Collecting Ducts

Figure26.15a,b

Water Balance Reflex:

Regulators of Vasopressin Release

Figure20-7:Factorsaffectingvasopressinrelease

Regulation by ADH
Released by posterior

pituitary when
osmoreceptors detect
an increase in plasma
osmolality.
Dehydration or
excess salt intake:

Produces
sensation of
thirst
Stimulates H20
reabsorption
from urine

A Summary of Renal Function

Figure26.16a

Step 1: Glomerulus
Filtrate
produced at
renal corpuscle
has the same
composition as
blood plasma:
without plasma
proteins

Step 2: Proximal Convoluted

Tubule (PCT)
Active removal
of ions and
organic
substrates:
produces
osmotic water
flow out of
tubular fluid
reduces volume
of filtrate
keeps solutions

Step 3: PCT and

Descending Limb
Water moves into
peritubular
fluids, leaving
highly
concentrated
tubular fluid
Reduction in
volume occurs
by obligatory
water

Step 4: Thick
Ascending Limb
Tubular cells
actively
transport Na+
and Cl out of
tubule
Urea becomes
higher
proportion of
total osmotic
concentration

Step 5: DCT and Collecting Ducts

Final
adjustments in
composition of
tubular fluid
Osmotic
concentration is
adjusted through
active transport
(reabsorption or
secretion)

Step 6: DCT and

Collecting Ducts

Final
adjustments in
volume and
osmotic
concentration
of tubular fluid
Exposure to
ADH determines
final urine
concentration

Step 7: Vasa Recta

Absorbs solutes
and water
reabsorbed by
loop of Henle
and the ducts
Maintains
concentration
gradient of
medulla

CONTROL OF
URINE VOLUME
AND
CONCENTRATION

REGULATION OF URINE
CONCENTRATION
Medullary countercurrent system
Vasopressin

12/19/16

Formation of Concentrated Urine

ADH (ADH) is the

signal to produce
concentrated urine
it inhibits diuresis
This equalizes the
osmolality of the
filtrate and the
interstitial fluid
In the presence of
ADH, 99% of the
water in filtrate is
reabsorbed

Formation of Dilute Urine

Filtrate is diluted in the

ascending loop of Henle if the

antidiuretic hormone (ADH) or
vasopressin is not secreted
Dilute urine is created by
allowing this filtrate to continue
into the renal pelvis
Collecting ducts remain
impermeable to water; no
further water reabsorption
occurs
Sodium and selected ions can
be removed by active and
passive mechanisms
Urine osmolality can be as low
as 50 mOsm (one-sixth that of
plasma)

URINE TRANSPORT,
STORAGE, AND
ELIMINATION

Urine Transport,
Storage, and Elimination
Takes place in the urinary tract:
ureters
urinary bladder
urethra

Organs for the Conduction

and Storage of Urine

Organs for the Conduction

and Storage of Urine

Figure 2618c

The Ureters
Are a pair of muscular tubes
Extend from kidneys to urinary bladder
Begin at renal pelvis
attached to posterior abdominal wall
Penetrate posterior wall of the urinary bladder
Pass through bladder wall at oblique angle
Ureteral openings are slitlike rather than
rounded
Shape helps prevent backflow of urine:
when urinary bladder contracts

3 Layers of the Ureter Wall

Inner mucosa:
transitional epithelium and lamina propria

Middle muscular layer:

longitudinal and circular bands of smooth
muscle

Outer connective-tissue layer:

continuous with fibrous renal capsule and
peritoneum

Peristaltic Contractions

Begin at renal pelvis

Sweep along ureter
Force urine toward urinary bladder
Every 30 seconds

Urine flow through ureters

Urine is not flowing through the ureter, but
goes to the bladder as an urinary spindle.
Starts with the sucking up of the urine
during the diastolic phase closing of
collecting ductus peristaltic movements.
Small amounts of urine are emptied into the
bladder from the ureters about every 10 to
15 seconds.

Bladder

87

The Urinary Bladder

Is a hollow, muscular organ
Functions as temporary reservoir urine
storage
Full bladder can contain 1 liter of urine

Bladder Position

Is stabilized by several peritoneal folds

Posterior, inferior, and anterior surfaces:
lie outside peritoneal cavity

Ligamentous bands:
anchor urinary bladder to pelvic and pubic bones

Umbilical Ligaments
Are vestiges of 2

umbilical arteries
Middle umbilical
ligament extends:
from anterior,
superior border
toward
umbilicus
Lateral umbilical
ligaments:
pass along sides
of bladder to

The Mucosa
Lining the urinary bladder has folds
(rugae):
that disappear as bladder fills

The Trigone of the Urinary Bladder

Is a triangular area bounded by:
openings of ureters
entrance to urethra

Acts as a funnel:
channels urine from bladder into urethra

Urethra
Extends from the

base of the bladder

to the outside
world.
Anatomical
differences mean
that male and
female urethras
are different.
Female :4cm
long
Male: 14cm
long

91

The Urethral Entrance

Lies at apex of trigone:
at most inferior point in urinary
bladder

The Neck of the Urinary Bladder

Is the region

surrounding
urethral opening
Contains a
muscular internal
urethral sphincter
(sphincter
vesicae- Smooth
muscle fibers of
sphincter provide
involuntary
control of urine

Wall of the Urinary Bladder

Contains mucosa, submucosa, and
muscularis layers:
form powerful detrusor muscle of urinary
bladder
contraction compresses urinary bladder and
expels urine

The Urethra
Extends from neck of urinary
bladder
To the exterior of the body

The Male Urethra

Extends from neck of urinary bladder
To tip of penis (1820 cm)

3 Parts of the Male Urethra

1. Prostatic urethra:

passes through center of prostate gland

2. Membranous urethra:

urogenital diaphragm

3. Spongy urethra (penile urethra):

extends from urogenital
diaphragm

The Female Urethra

Is very short (35 cm)
Extends from bladder to vestibule
External urethral orifice is near
anterior wall of vagina

The External Urethral Sphincter

In both sexes:

is a circular band of skeletal muscle

where urethra passes through urogenital
diaphragm
Acts as a valve
Is under voluntary control:
via perineal branch of pudendal nerve
Has resting muscle tone
Voluntarily relaxation permits micturition

Physical Characteristics of Urine

Color and transparency
Clear, pale to deep yellow (due to urochrome)
Concentrated urine has a deeper yellow color
Drugs, vitamin supplements, and diet can change the
color of urine
Cloudy urine may indicate infection of the urinary tract

pH
Slightly acidic (pH 6) with a range of 4.5 to 8.0
Diet can alter pH

Specific gravity
Ranges from 1.001 to 1.035
Is dependent on solute concentration

Chemical Composition of Urine

Urine is 95% water and 5% solutes

Nitrogenous wastes include urea, uric acid,

and creatinine
Other normal solutes include:
Sodium, potassium, phosphate, and
sulfate ions
Calcium, magnesium, and bicarbonate
ions
Abnormally high concentrations of any
urinary constituents may indicate

Micturition
From the kidneys urine flows down the ureters to

the bladder propelled by peristaltic contraction of

smooth muscle.
The bladder is a balloon-like bag of smooth
muscle = detrussor muscle contraction of
which empties bladder during micturition.
Pressure-Volume curve of the bladder has a
characteristic shape.
There is a long flat segment as the initial
increments of urine enter the bladder and then a
sudden sharp rise as the micturition reflex is
triggered.

Normal Micturition Physiology

2 phases

Filling and emptying

Normal micturition cycle requires that the
urinary bladder and the urethral sphincter
work together as a coordinated unit to
store and empty urine
Storage
Bladder is a low-pressure receptacle
Urinary sphincter closed with high resistance to
urinary flow

Emptying
Bladder contracts to expel urine
Urinary sphincter opens to allow urinary flow

Normal Micturition Physiology

Filling phase
Bladder
Accumulates increasing volumes of urine
Pressure inside the bladder remains low
Pressure within the bladder must be < than the
urethral pressure during the filling phase

Bladder filling dependent on

Intrinsic viscoelastic properties of the bladder
Inhibition of the parasympathetic nerves

Bladder filling primarily is a passive or

active event?

Normal Micturition Physiology

Bladder filling
Sympathetic nerves also facilitate urine
storage
Inhibition of the parasympathetic nerves

from triggering bladder contractions

Directly cause relaxation and expansion of
the detrusor muscle.
Close the bladder neck by constricting the
internal urethral sphincter

Thus, sympathetic input to the lower

urinary tract is constantly active during
bladder filling.

Normal Micturition
During bladder filling - pudendal nerve becomes excited.
Pudendal nerve stimulation contraction of the
external urethral sphincter
Urethral pressure maintained by the continence
mechanism, which is composed of ??
Contraction of the external sphincter
Contraction of the internal sphincter

Pressure gradients
Continence = urethral pressure > or < bladder
pressure
Incontinence = urethral pressure < or > intravesical
pressure is abnormally high

Normal Micturition Physiology

Pressure Gradients

During bladder filling

Small in intravesical pressure
When the urethral sphincter is closed, the

intraurethral pressure > the intravesical pressure

With intraabdominal pressure (cough,

sneeze, laugh, physical activity), some
pressure transmitted to both the bladder
and urethra
If the pressure is evenly transmitted to both the
bladder and urethra, incontinence
If pressure transmitted to the bladder is >
urethra, stress incontinence results

Normal Micturition Emptying

Involuntary (reflex) or voluntary
Infants involuntarily reflex void when the
volume of urine exceeds the voiding
threshold
Bladder wall stretch receptors sacral cord
pudendal nerve

relaxation of the levator ani relaxation of pelvic floor

muscle
Opens external sphincter

Also, sympathetic nerves relaxation of internal

sphincter
Parasympathetic nerves detrusor contraction
Bladder pressure > urethral pressure urinary

Normal Micturition Emptying

A repetitious cycle of bladder filling and

emptying occurs in newborn infants

As the infant brain develops, the PMC also
matures and gradually assumes voiding
control
During childhood, primitive voiding
reflex becomes suppressed and the
brain dominates bladder function
Toilet training usually is successful at age 2-4
years
Primitive voiding reflex may reappear in people

Delayed/Voluntary Voiding
Healthy adults are aware of bladder filling and

can willfully initiate or delay voiding

Normally, the PMC functions as an on-off switch
that is activated by stretch receptors in the
bladder wall and is modulated by inhibitory and
excitatory neurologic influences from the brain.
When voiding must be delayed
Brain bombards the PMC with inhibitory signals
to prevent detrusor contractions
Individual actively contracts the levator
muscles to keep the external sphincter closed

Normal Micturition Delayed

Emptying
Voiding = coordination of both the
ANS and somatic nervous system,
which are in turn controlled by the
PMC located in the brainstem and
regulated by the brain

Normal Micturition Delayed

Emptying
Voiding = coordination of both the
ANS and somatic nervous system,
which are in turn controlled by the
PMC located in the brainstem and
regulated by the brain

Pressure-volume graph for normal human

bladder

Pressure (kPa)

1.2
5
1.0
0
0.7
5
0.5
0

1st
desire
to
empty
bladder

Discomfor
t

Sense of
urgency

0.2
5
10
0

20
30
0
0
Volume (ml)

40
0

Micturition (Voiding or Urination)

Bladder can hold 250 - 400ml

Greater volumes stretch bladder walls

initiates micturation reflex:

Spinal reflex
Parasympathetic stimulation causes
bladder to contract
Internal sphincter opens
External sphincter relaxes due to inhibition

Urination: Micturation reflex

Figure19-18:Themicturitionreflex

Micturition (Voiding or Urination)

Figure25.20a,b

REGULASI ASAM BASA

Maintaining Acid-Base Balance

in Blood
Blood pH must remain between
7.35 and 7.45 to maintain
homeostasis
Alkalosis pH above 7.45
Acidosis pH below 7.35

Most ions originate as byproducts

of cellular metabolism
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ENZYM DAN SISTEM SYARAF PEKA

THD PERUBAHAN pH

Bila asidosis (pH menurun) maka:

- Neuron kurang peka thd
rangsangan
-SSP depresi
- Pend bingung, disorientasi, masuk
koma.
- Bila depresi ssp progresif
kegagalan pernapasan - mati

Bila alkalosis (pH meningkat)

maka:
-neuron mudah dirangsang -
otot kontraksi
- bila alkalosis berat - otot
tetanus
-paralisis otot pernapasan

Gangguan asam-basa berkaitan dengan

gangguan keseimbangan K+.
Dalam keadaan seperti ini ginjal
memindahkan 2 ion, yaitu:
- pada asidosis ginjal membuang H+
dan reabsorpsi K+
-pada alkalosis ginjal mengekskresi
K+, reabsorpsi H+
- akibat asidosis/alkalosis gangguan
jantung

ASAM-BASA DALAM TB. DATANG DAI BANYAK SUMBER

HOMEOSTASIS Ph TGT DARI BUFFER, PARU DAN GINJAL

Blood Buffers
Molecules react to prevent
dramatic changes in hydrogen ion
(H+) concentrations
Bind to H+ when pH drops
Release H+ when pH rises

Three major chemical buffer

systems
Bicarbonate buffer system
Phosphate buffer system
Protein buffer system

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The Bicarbonate Buffer System

Mixture of carbonic acid (H2CO3) and
sodium bicarbonate (NaHCO3)
Bicarbonate ions (HCO3) react with
strong acids to change them to
weak acids
Carbonic acid dissociates in the
presence of a strong base to form a
weak base and water
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Respiratory System Controls of

Acid-Base Balance
Carbon dioxide in the blood is
converted to bicarbonate ion and
transported in the plasma
Increases in hydrogen ion concentration
produces more carbonic acid
Excess hydrogen ion can be blown off
with the release of carbon dioxide from
the lungs
Respiratory rate can rise and fall
depending on changing blood pH

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Renal Mechanisms of AcidBase Balance

Excrete bicarbonate ions if needed
Conserve or generate new
bicarbonate ions if needed
Urine pH varies from 4.5 to 8.0

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