ENH 220 Class 7 Urinary and Gastrointestinal PDF

Pre-Lecture Urinary Kidneys ○ Size of your fist ○ In location just near lower ribs, towards your back ○ Not freefloating, they’re logged in different structures I.e. peritoneum which is serous membrane-sac like muscle that keeps...

Pre-Lecture Urinary Kidneys ○ Size of your fist ○ In location just near lower ribs, towards your back ○ Not freefloating, they’re logged in different structures I.e. peritoneum which is serous membrane-sac like muscle that keeps abdominal organs in place Psoas major is erector muscle that runs up and down sides of spine to keep you upright and lock kidneys in place Unless Any failure with these structures which is impossible unless injury tears it, the kidneys will not likely move ○ Left kidney is higher than right because location of liver, peritoneum and blood vessels ○ A lot of blood vessels because urine comes from blood, creation of urine = body achieving homeostasis, keeping pH and fluid of blood in the right range ○ Blood leaves the kidney via inferior vena cava is filtered and cleaned already before going into the heart then into lungs for oxygen then back into body ○ Renal arteries are important part of kidneys ○ Kidneys filter your blood between the renal vein (bringing blood out) ○ Renal artery brings blood to kidneys to be cleaned and or be filtered ○ Most important substance kidney reabsorbs is proteins ○ Outer cortex of kidney Made of reticular fibers, spongy type of tissue which holds well ○ Renal cortex, like the body of the kidney ○ Inside is called medulla ○ Outer region cortex contains important things like glomeruli, glomerulus, and part of the nephron tubules, which are very important because nephron = exchange takes place of wastes, reaborption of important fluids/things like proteins ○ Loops of Henley ○ Renal pyramids = sites of areas where nephron and loop of henley will go into, blood vessels run around these pyramids ○ Renal coloumns partly responsible for structure and some blood vessels there ○ Interlober arteries, go between the lobes of renal columns and work in tandem with micro blood vessels running around the renal pyramids ○ The larger blood vessels go through renal columns, and blood filtered around renal pyramids ○ Renal sinus makes up calluses ○ Renal pelvis is base part of kidney where the kidney and ureter connect to each other Major calluses Major branches will allow smaller structures aka the minor calluses to collect the waste and fluids to build together This is where the fluid will collect, and the collection of fluids will be from smaller connections from collecting duct ○ Ureters = long narrow tube with a muscular wall Propels urine towards bladder by peristalsis These go into the bladder at an angle and act as partly a one way valve to prevent urine from flowing back ○ Psosa’s major is at the bottom of the kidney, and the fat surrounds it as part of the perioneum ○ Nephrons are the same Blood will go through the kidney through rena artery and then around segmental arteries and importantly through interlober arteries, then into arcuate artery Arcuate arteries are branches around the arc of the renal pyramids The important nephron looks like a pipe under a sink ○ Nephron is where filtration, reabsorption, secretion of certain things occurs ○ The arcuate vein will take filtered blood back into the renal vein up to the heart to be oxygenated and clean, to go back into the actual nephron ○ Bowman’s capsule or the glomerulus Part of the nephron Forms some sort of cup Where everything occurs Sensitive part ○ Afferent arterial Small blood vessel ○ Kidneys can be easily damaged and natural death is kidney failure because loss of function comes from nephron death or tissue breakdown ○ Taking a legal drug By the time metabolic breakdown in the liver occurs, some drugs do metabolize more with kidney ○ Glomerulus is very delicate structure, can be damaged with concentration of toxin or high concentrations of a toxicant ○ Capillaries at the front part, called a tuft, main filtering unit of kidney ○ Bowman’s capsule is surrounded by bowman’s space, blood vessels inside are called peritubular capillaries which go around loop of henle ○ After glomerulus is proximal convoulated tubule A space that can get damaged due to high concentrations of types of toxins ○ Main readorption takes place in loop of henle, which is inside renal pyramid ○ Proximal convoluted tubule, descending loop and the ascending loop this is where fluids will see site of absorption, filtrate waste ○ First formation of urine as fluids that go through loop of henele the transfer goes between the vasorecta which are blood vessels that do transfer based on blood pressure ○ Important to have healthy bp because kidneys can be injured by hypertension or high bp so you get a diffusion out of the artery in the descending and then  diffusion or reabsorption in ascending tubule, more typical because blood is cleaned now (what returns to kidney itself) ○ Distance convulated tubules will allow more absorption of necessary nutrients and proteins returned into paratubular vein then interlobular vein then arcuate vein and then empties out into major structures out into renal vein and out to vena cava and then to heart to get oxygenated ○ How the body maintains homeostasis Aka the last section of the nephron The waste started at glomerulus and went through entire nephron will be emptied at collecting duct and part of that will be balancing water Collecting duct will go out into the ureter through the major structures into the bladder ○ Nephrons have collecting ducts which bind together to bigger structure, end up at the minor calluses of renal pelvis ○ They then all join even more to major calluses of renal pelvis then the renal pelvis itself and then to ureter ○ Urine goes down these structures (ureter coming down from kidney) towards the urinary bladder ○ Bladder is made of stretchy type of tissue, transitional epithelium, made up transitional cells ○ Bladder has a trigone = itself has to be functional, ureter comes into the bladder at this point, acts as a backstop measure ○ The trigone helps stop backflow of urine, located in internal wall of bladder, on posterior part aka where ureter enters ○ Trigone empties out into urethra ○ Ectopic ureter = ureter out of place or its out of trigone Means something grown or formed ○ For females there’s sphincters that control output of urine Internal spinchter is in inner surface Has some voluntary control, but majorly involuntary control External urethral sphincter is on external side Has voluntary control Helps when you have to hold pee really bad ○ For males, they have prostates and testes Prostates secrete seminal fluid and works in tandem with other glands so semen is transported ○ Only real difference is that trigone empties through prostate for males unlike females The internal urethral spincter is part of top prostate which can be problematic for age because with age prostate becomes swollen, become infected and make emptying bladder more problematic ○ Most of urethra is internal, where structure of ureter exists body is penis itself ○ It’s hard to treat bladder infections in males  I.e. the vas deferens that goes into the testicles can be infected by similar bacteria, thus males get UTI less frequently, but when they do its more complex treatment Pre-Lecture Gastrointestinal GI tract starts with head and the mouth where we initially start digestion to break down the large pieces of nutrition Then go under a series of metabolic steps in the body to gain benefit Food pipe = esophagus, in the back of the throat all the way to the top of stomach ○ Stretchy tube made up of transitional cells banded together as a loop You could trigger a spasm aka peristalsis is interrupted when feel that something’s “stuck” in the esophagus ○ The first juncture is the cardiac sphincter which is important as it closes off the stomach acid and not the esophagus because esophagus doesn’t have same mechanisms as stomach to protec itself ○ Pyloric sphincter = allows for timed and regulated emptying of stomach into duodenum Stomach can stretch several time to its normal size 4 layers of tissue make up stomach wall Serosa mucosa = stomach bag, the outside part of the somach Outermost muscle ○ Longitudinal because direction of bands Circular muscle ○ Runs around stomach underneath outer layer Oblique or inner muscle layer after The layers are overlaid to create stong type of tissue Tunica mucosa = mucosa is an important layer, inside the stomach and inside the stomach itself or the inside wall, it is several things ○ Gastrin secretes hydrochloric acid, needed to digest food ○ Inside the mucosa layer are prostaglandins associated with inflammation typically but they help secrete mucus in stomach ○ Mucus in the mucosa/wall of stomach protects stomach against the acid ○ If prostaglandins are suppressed then gastrin still produces acid and you end up with ulcers Duodenum is the first part of the small intestine after emptying stomach ○ Common site of ulcers Causes of ulcers are stomach acid If sphincter isn’t functioning properly or digestive enymes from pancreas or liver affect it Middle intestine or duodenum ○ Connects over into illum ○ This and illum are small bowel or small intestines ○ Both are important because they absorb majority of nutrients  ○ In the small intestine there is millions of vili (finger like projections) to increase surface area of small intestines Villi are in the circular folds ○ Longitudinal muscle layer → circular one → innermost is submucosa → mucosa wall with ridges aka villi ○ Supplied by blood vessels and nerves inside mesentery Mesentery is a mechanism to hold intestines Its the blood vessels and nerves that control peristalsis Lymph vessels are also present Mucosa-associated lymphoid tissue ○ Important for immunity in small intestine ○ Ileocecal junction: small intestine ileum meets cecum First part of the large intestine or large bowel Everything coming through this would be liquid known as chyme Appendix ○ Most common site of problems with the large bowel Ascending colon ○ Goes up ○ Cecum is technically a part of the ascending colon Tennia ○ Part of the muscle system responsible for peristalsis The muscles running around colon which is the large bowel or intestine help moves things along Transverse colon goes across ○ High levels are reabsorption of water as it’s liquidy coming in the ascending colon or into cecum ○ Production of vitamin B and K Descending colon ○ Quite narrow compared to counterparts the ascending and transverse colon Important for detecting cancer Tenon towards the distal end or far end of colon, down towards the pelvic bone is where stool starts to form ○ Water is really drawn out but too much or diarrhea comes Sigmoid colon is last part of the colon itself ○ Formation of stools Rectum ○ The proximal or top part of rectum is called rectal vault Specific valves in here allows you to pass gas without defecating, important sort of storage area ○ Distal end of rectum ○ Anal canal and anal opening which is end of digestive tract Typically conspiration starts at sigmoid colon, but because so much water was drawn out, the impact known as fecal impaction occurs, not blockage  Helps maintain homestasis and responsible for waste If appendix explodes or perforation occurs, you could empty liquid contents of cecum right into abdomen, your peritoneum which is dangerous In class Lecture: Cogenital Abnormalities Regnal agenesis ○ Failure of one or both kidneys to develop ○ Bilateral → rare ○ Unilateral → common Hypertensive Nephrosclerosis ○ Complication of severe hypertension Thickening of arterioles, high blood pressure, tubules go under secondary degenerative changes causing narrowing of blood flow ○ Common cause of chronic renal disease ○ Reduced glomerular filtration because of high blood pressure ○ Kidneys shrink ○ May progress to ESRD Diabetic Nephropathy ○ Complication of long-standing diabetes ○ Manifestations Progressive impairment of renal function Protein loss may lead to nephrotic syndrome Nephropaties: Glomerulonephritis ○ Inflammation of glomeruli caused by antigen-antibody reaction within glomeruli ○ Immune-complex glomerulonephritis Nephoritc Syndrome ○ Marked loss of protein in the urine ○ Failure of filtration barrier in the glomerulus ○ Protein is lost in urine ○ Protein levels in blood falls ○ Causes edmea due to low plasma osmotic pressure ○ Clinical manifestations Marked leg edema Ascites ○ Prognosis: In children: minimal change disease, complete recovery In adults: manifestation s of progressive renal disease Acute Renal Tubular Injury ○ Pathogenesis Impaired renal blood flow Tubular necrosis caused by toxic drugs or chemicals  Death of tissues ○ Clinical manifestations Acute renal failure: Oliguria, anuria Tubular function gradually recovers Treated by dialysis until function returns Tubulointerstitial Nephritis Both tubules and surrounding interstitium affected Often an allergic reaction to the drug Low grade fever, joint pain, and a typical rash Causes Granulomas in the kidney to cause inflammation Typically resolves without therapy by discontinuing drugs Renal Cysts Solitary cysts common; not associated with impairment of renal function Multiple cysts uncommon; may be associated with impaired renal function ○ Congenital polycystic kidney disease Birth ○ Autosome (adult) dominant polycystic kidney disease Comes later in life ○ If its progressing fast, there’ll be onset renal failure for middle age ○ In the event that kidney itself is so engrossed of cysts, it’ll be palpable so they can see kidney under the ribcage or a bump in the back Renal Tumours Cortical tumours: arise from epithelium of renal tubules ○ Usually benign, but sometimes can be cancerous Adenomas usually small and asymptomatic ○ White small nodules under biopsy ○ Benign Carcinomas more common of kidney cancers ○ Hematuria (blood in urine) is first sign ○ Cancer will invade renal vein and metasize into bloodstream if not treated, it’ll be aggressive because it’s on vena cava so it’ll go to heart then other parts ○ Treatment is they take out the nephrectomy (take kidney out) and resect veins or vena cava if they can Nephroblastoma (Wilms Tumour) Uncommon, highly malignant Affects infants and kids ○ Kids can survive, but it’s aggressive ○ 90% survival rate after 5 years, 80% after Fatal if not caught early Found in pyramids or medulla of kidney Strongly impacts vasculature inside kidney and compress outer collecting ducts and ureter Requires removal of kidney, chemo and radial therapy Vesicoureteral Reflux The ureter can see backflow aka etopic ureter if ureter is outside trigone Trigone keeping the shape to make funnel for urether prevents backflow but in this disease, as backflow increases pressure on ureter increases Ureter becomes saggy and pylonnephretis and utis possible Renal Calcuili Kidney Stones may form anywhere in the urinary tract ○ Bladder itself and kidney Predisposing factors ○ High concentration of salt in urine ○ Uric acid ○ Calcium salts from hyperthyroid or hyperparathyroidism ○ Urinary tract infections that reduce solubility of salt in urines They can block ureter entirly The pain that comes from the stones is when there’s blockages, urethers and kidney spasm because backflow of fluids; as they spasm triggers very precise set of nerves (uretic nerves) along ureter which are wound around it so they constantly emit a nervous signal so pain is fairly constant as stones move out ureter then passed out urethra Typically not dangerous, let it run its course or you can lithotripsy to break stone itself When it becomes dangerous: ○ Staghorn calculus aka urinary stones which look like large horns on top ○ Stones increase in size and invade structures of kidney, adapt to renal pelvis and renal calluses which means some stones pass but others wont which causes renal colic aka renal pain Surgical removal of it or at one point kidney removal Chronic Renal Disease Renal function fails as the number of functioning nephrons declines to 30% of normal Remaining nephrons ”work harder” at higher blood pressure and are injured Abnormal renal function for > 3 months is chronic renal disease ○ Basically if your nephrons don’t work for more than 3 months you have chronic renal disease Chronic renal disease may progress to end-stage renal disease (ESRD) ESRD requires treatment such as dialysis or renal transplant to sustain life End-Stage Renal Disease (Uremia) Retention of excessive by-products of protein metabolism in the blood ○ Body keeps byproducts of metabolism in blood, typically from protein metabolism Fluid, electrolyte, acid-base regulation fail ○ Changes in carbonic acid ○ Weakness ○ Toxic manifestations (blood becomes more acidic) Metabolic acidosis occurs  Lack of erythropoietin (blood cell reproduction slows) leads to anemia Level of urea in blood (blood urea nitrogen BUN) correlates with clinical condition Measurement of severity of renal failure Edema, nausea, weakness, vomiting, hypertension, basically body out of control Dialysis or renal transplant Renal Failure Renal failure is the inability of kidneys to regulate and excrete Uremia is the end stage of many kidney diseases. Associated with: ○ Retention of urea in the blood ○ Metabolic acidosis ○ Ketoacidosis (dangerous amount of ketones in the blood) derived from fat metabolism Urinary Tract Infections/Cystitis Very common; may be acute or chronic Most infections are caused by gram-negative bacteria (e.coli) ○ Typically clings on wall of bladder and ascends urethra very easily ○ Super easily treatable Not treating it tho can cause chronic inflammation to the bladder and infection of ureters, and even to kidneys When you have a chronic inflammation, potential to lead to menoplasia or dysplasia, for bladder itll be risk of cancer (pink or red urine) Because its epithelial type of tumor it’ll rapidly spread and possibly affect to organs nearby Cystitis Affects only the bladder More common in women than men; urethra in females is shorter; in young, sexually active women, sexual intercourse promotes the transfer of bacteria from the urethra to the bladder Common in older men because an enlarged swollen prostate interferes with complete bladder emptying, stagnation of urine favors bacterial growth GI Tract Esophagus Abnormalities Two major disturbances of cardiac sphincter ○ Cardiospasm (Achalasia) Spincher will fail to open properly Malfunction of set of nerves ^ Esophagus becomes dilated and food will start to retain in the area rather than pass the spincter ○ Incompetent cardiac sphincter  Sphincter remains open and stomach acid will leak into esophagus Complications arise with acid reflux Over time reflux esophagitus will occur like heart-burning type of feel and when you lie down esophagus will erode, ulcerated or scarred Condition may arise aka baretts esophagus aka metaplasia (squamous to column epithelium) to lead to cancer Obstruction: ○ Carcinoma or tumour: Can arise anywhere in esophagus Tumour will narrow the pipe aka lumen so more pain swallowing and pressure Esophagus invade nearby tissue and spread of esophageal cancer comes too late for major intervention because its aggressive cancer ○ Stricture: From scar tissue due to necrosis and inflammation from corrosive chemicals, such as lye; also can occur from exposure to stomach acid long-term Mucosal tears: ○ Caused by retching and vomiting ○ Linear tears in the mucosa or lining of esophagus ○ Leads to bloody vomit Acute Gastritis Inflammation of the gastric lining Self-limited inflammation of short duration May be associated with mucosal ulceration or bleeding Associated with lifestyle (alcohol and smoking) and some medications Helicobacter pylori Gastritis Small, curved, gram-negative organisms that colonize the surface of gastric mucosa Grow within layer of mucus covering epithelial cells ○ Grow part of stomach lining where stomach protects itself from stomach acid ○ Overtime they produce urease enzyme that decomposes urea a product of metabolism and turns it into ammonia (neutralizes gastric acid) and thus why h.pylori hangs around stomach and they start to break down the mucus layer itself Most common cause of ulcers Can passed through contact with waste or saliva like kissing, fecal route, etc. Type of cancer associated to H.pylori called Amalt (mucosa-associated lymphoid tissue cancer) and cause early can be treated with antibiotic therapy and typically radiation and even chemo If u have h.pylori get it checked out! Peptic Ulcer Pathogenesis ○ Digestion of mucosa (layer of stomach that’s protection) due to increased acid secretions or digestive enzymes like h.pylori (gastric acid and pepsin)  ○ Common sites: Distal stomach or proximal duodenum ○ Complications: Hemorrhage, perforation, peritonitis, obstruction from scarring Antibiotics and antiacids, proton pump inhibitors and other drugs used to treat Enteritis Acute enteritis ○ Intestinal infections; common; of short duration ○ Nausea, vomiting, abdominal discomfort, loose stools Chronic enteritis ○ Less common, more difficult to treat ○ Affects distal illeum usually ○ Regional enteritis or Crohn’s disease ○ Chronic inflammation and ulceration of mucosa, thickening or scarring of bowel wall leads to narrowing, and inflammation that’s scattered Meckel’s Diverticulum Outpouching at distal ileum, 12 to 18 inches proximal to cecum From persistence of a remnant of the vitelline duct, narrow tubular channel connecting small intestine with yolk sac embryologically Usually in kids and babies Genetial abnormality Mistaken usually for appendicitis Quite close to cecum itself Colitis What is Colitis? ○ Inflammation of the inner lining of the colon ○ Symptoms include abdominal pain, diarrhea, and rectal bleeding Types of Colitis: ○ Ulcerative Colitis ○ Crohn’s Disease ○ Infectious Colitis ○ Ischemic (low blood flow) Colitis Can be very dangerous and result of surgery Diagnosis: ○ Diagnosis through colonoscopy, CT scans, and blood tests Irritable Bowel Syndrome Also known as spastic colitis or mucous colitis Episodes of crampy abdominal discomfort, loud gurgling bowel sounds, and disturbed bowel function without structural or biochemical abnormalities Excessive mucus secreted by colonic mucosal glands ○ It can cause infection and pain Appendicitis  Appendicitis: Most common inflammatory lesion of the bowel ○ Generalized abdominal pain localizing in right lower quadrant; rebound tenderness First treatment is surgery (appendectomy) but theyre starting to do antibiotics Intestinal Obstructions Conditions blocking normal passage of intestinal contents High intestinal obstruction ○ Severe, crampy abdominal pain from vigorous Peristalsis Low intestinal obstruction ○ Symptoms less acute ○ Mild, crampy abdominal pain Common causes of intestinal obstruction ○ Adhesions ○ Hernia ○ Tumor ○ Volvulus ○ Intussusception Hernia Types Hernia is protrusion of loop of bowel through a small opening in the abdominal wall typically small bowel; this herniated loop pushes through peritoneum to form hernial sac ○ You can get umbilical hernia, inguinal hernia, or femoral Inguinal common in men because inguinal canal where musculature and blood vessels go through this and attaches to testicle Loop of small bowel will prptude inguinal ring and goes to scrotum As you cough it’ll be palpable Umbilical can come in pregnancy , loop will protrude umbilicus and can be dangerous if there was unknown defect, typically from exertion Femmoral runs near femur and extends under inguinal ligament along femoral blood vessels into groin (Both guys and girls) Treatable by surgery, pushed back and surgically plastered in there If it cant be pushed back its called incarcerated hernia and surgery could remove the part of bowel ○ Important for strangulated hernia, loop is tightly constricted so blood supply fails Intussusception Telescpoing of segment of bowel into adjacent part of it aka into itself ○ Think about hose pushing into itself Mesentee pulled into intersection it chokes off blood supply and bowel will die due to necrotization  ○ dangerous!! Diverticulosis Diverticulosis: Outpouchings or diverticula of colonic mucosa through weak areas in the muscular wall of large intestine Acquired, usually asymptomatic, seen in older people, low residue and fiber diet Common site: Sigmoid colon Diverticulitis: Inflammation incited by bits of fecal material trapped within outpouchings Complications: Inflammation, perforation, bleeding, scarring, abscess Chronic constipation can lead to this Treatment depends on advancement and type of infection, but managable with lifestyle changes and diet, complications can be inflammation and worst cause perforation the diverticula ruptures Hemorrhoids Comes from Constant constipation or straining Worst case is surgery if they prolapse but they just cause pain and discomfort Varicose veins of hemorrhoidal venous plexus that drains rectum and anus Internal hemorrhoids ○ Veins of the lower rectum ○ May erode and bleed, become thrombosed, or prolapse External hemorrhoids ○ Veins of anal canal and perianal skin (purplish and blue) ○ May become thrombosed, causing discomfort ○ Common cause of red blood on toilet paper Common in pregnant people (internal) Tumours of the Colon Benign: pedunculated polyps ○ Polyp with a stalk Other one is flat polyp called sessile on wall ○ Frequent, will increase in large bowel with age ○ Tip may erode, causing bleeding (not necessarily bad) ○ Removed by colonoscopy Carcinoma ○ Cecum and right half of colon up ascending colon and transverse Does not cause obstruction because caliber is large and bowel contents are relatively soft Chyme as it goes through and content are soft Tumour itself can grow and you won’t know it It can ulcerate and lead to iron deficiency Left half of colon ○ Causes obstruction and symptoms of lower intestinal obstruction ○ More pain, you might have to take colon out like a part of it or colonoscopy