Term
64 yo woman
history of MI; in the ER with SOB
previous 2 weeks - dyspnea on exertion and swelling of her legs; sleeps on 3 pillows because coughs and SOB if lays flat
in ED - sitting upright; moderate respiratory distress; tachycardic and hypertensive; JVD to the angle of her jaw
on auscultation of lungs - wet rales bilaterally
pitting edema in both legs up to her knees
what is the term for the fact that she is sleeping on 3 pillows at night? |
|
Definition
|
|
Term
64 yo woman
history of MI; in the ER with SOB
previous 2 weeks - dyspnea on exertion and swelling of her legs; sleeps on 3 pillows because coughs and SOB if lays flat
in ED - sitting upright; moderate respiratory distress; tachycardic and hypertensive; JVD to the angle of her jaw
on auscultation of lungs - wet rales bilaterally
pitting edema in both legs up to her knees
a chest x-ray confirms the diagnosis of? |
|
Definition
| pulmonary edema consequence of CHF |
|
|
Term
64 yo woman
history of MI; in the ER with SOB
previous 2 weeks - dyspnea on exertion and swelling of her legs; sleeps on 3 pillows because coughs and SOB if lays flat
in ED - sitting upright; moderate respiratory distress; tachycardic and hypertensive; JVD to the angle of her jaw
on auscultation of lungs - wet rales bilaterally
pitting edema in both legs up to her knees
she is placed on oxygen and immediately given an IV injection of? |
|
Definition
diuretic
furosemide - high ceiling diuretic that gives large effect quickly |
|
|
Term
64 yo woman
history of MI; in the ER with SOB
previous 2 weeks - dyspnea on exertion and swelling of her legs; sleeps on 3 pillows because coughs and SOB if lays flat
in ED - sitting upright; moderate respiratory distress; tachycardic and hypertensive; JVD to the angle of her jaw
on auscultation of lungs - wet rales bilaterally
pitting edema in both legs up to her knees
what is the mechanism of pulmonary edema with CHF? |
|
Definition
heart stops working effectively
get back-fill pressure into the lungs
increase hydrostatic pressure
drives water into the interstitium
if no inflammation or infection - accumulates around large BV
seen on x-ray or high resolution CT - called thickened septal line |
|
|
Term
| total amount of fluid in body |
|
Definition
|
|
Term
| fluid makes up what percentage of total body weight? |
|
Definition
|
|
Term
| where is body fluid distributed? |
|
Definition
1. cells - 30-40%
2. interstitium
3. plasma - primary component |
|
|
Term
|
Definition
| portion of blood that is cells |
|
|
Term
| what portion of the blood is made of red cells? |
|
Definition
| about 42% in women, 44-45% in men |
|
|
Term
| what are the 3 phases of a blood sample? |
|
Definition
1. RBC phase
2. buffy white coat - on top of red cell layer; immune and circulating cells
3. serum or plasma phase - on top of buffy coat; fluid phase |
|
|
Term
| what percentage of total volume of blood is fluid? |
|
Definition
|
|
Term
| how is body fluid is divided? |
|
Definition
| intracellular and extracellular fluid |
|
|
Term
| what organ determines the amount of water in the body? |
|
Definition
|
|
Term
| what is located in the cortex? |
|
Definition
renal corpuscles (Bowman's capsule) - where glomerular filtration occurs
proximal convoluted tubule |
|
|
Term
| do all loop of Henle's go to the medulla? |
|
Definition
NO
some stay in cortex - close to the apical side of the kidney |
|
|
Term
| what is the functional unit of the kidney? |
|
Definition
|
|
Term
| how many nephrons are there? |
|
Definition
|
|
Term
| what are the 2 components of the nephron? |
|
Definition
|
|
Term
|
Definition
| capillary bed that maintains high hydrostatic pressure that drives solutes out of the capillary and into Bowman's space |
|
|
Term
|
Definition
| series of specialized epithelial cells arranged in segments, each of which selectively modifies the initial ultrafiltrate |
|
|
Term
| where is the nephron found anatomically? |
|
Definition
|
|
Term
| what is the target in the nephron for diuretic drugs? |
|
Definition
| the different ion channels and receptors in the different segments of the tubules |
|
|
Term
| what is unique about the arteriole anatomy of the kidney? |
|
Definition
| its the only place where there are 2 arterioles separated by a capillary bed |
|
|
Term
| what part of the kidney ultimately gives the final filtrate? |
|
Definition
|
|
Term
| why is the endothelium of glomerulus different from other endothelium? |
|
Definition
| it is fenestrated - has holes in the middle |
|
|
Term
| why is glomerular endothelium fenestrated? |
|
Definition
podocytes that encase endothelium secrete VEGF
endothelial cells in capillary plexus respond by making holes |
|
|
Term
| what is the purpose of the fenestrated endothelium in glomerular capillaries? |
|
Definition
used to filter solutes
large solutes go through
proteins do not |
|
|
Term
| why are proteins not filtered out of fenestrated glomerular capillary endothelium? |
|
Definition
because of the negative charge on the endothelium
if negative charge is lost (diabetes, pre-eclampsia) - lose protein (proteinuria) |
|
|
Term
| what is the function of podocytes? |
|
Definition
|
|
Term
| how do the epithelial cells of Bowman's capsule change as they move into the proximal convoluted tubule? |
|
Definition
| they become more columnar |
|
|
Term
| what determines glomerular filtration? |
|
Definition
| pressure and oncotic forces |
|
|
Term
| equation for GFR of a single nephron |
|
Definition
GFRsn = Kf x [(Pgc - Pbs) - (∏gc - ∏bs)]
Kf = filtration coefficient
Pgc = glomerular capillary hydrostatic presure
Pbs = Bowman's space hydrostatic presure
∏gc = glomerular capillary oncotic pressure
∏bs = Bowman's space oncotic pressure |
|
|
Term
|
Definition
| filtration coefficient = resistance of barrier to fluid flux |
|
|
Term
| based on hydrostatic pressure, when do you get filtration? |
|
Definition
|
|
Term
| which direction does water move? |
|
Definition
| towards the most protein - usually in blood |
|
|
Term
| what is the relationship between hydrostatic pressure and oncotic pressure in glomerular filtration? |
|
Definition
| oncotic pressure opposes hydrostatic pressure |
|
|
Term
| what is the major determinant of GFR? |
|
Definition
| usually fluid pressure in blood > oncotic pressure |
|
|
Term
| examples when fluid pressure in blood is not greater than oncotic pressure in the glomerulus? |
|
Definition
squeeze afferent arteriole - drops driving pressure
lose negative charge barrier - increase protein in Bowman's space - increase GFR |
|
|
Term
| is the hydrostatic pressure the same throughout the entire capillary loop? |
|
Definition
| NO - changes as move through the loop |
|
|
Term
| which part of the capillary loop has the highest hydrostatic pressure? |
|
Definition
| beginning of the capillary |
|
|
Term
| why does the hydrostatic pressure change as it moves through the capillary loop? |
|
Definition
| water is being filtered --> relatively concentrates protein --> increases oncotic pressure --> opposes filtration |
|
|
Term
| what is the effect on hydrostatic pressure across a single capillary segment? |
|
Definition
|
|
Term
| what are the major resistance sites in renal circulation? |
|
Definition
| afferent and efferent arterioles |
|
|
Term
| what are the major sites that control renal blood flow and why? |
|
Definition
| afferent and efferent arterioles because they are the major resistance sites |
|
|
Term
| where is there exchange in renal circulation? |
|
Definition
| only the capillaries - glomerular and peritubular |
|
|
Term
| why do the glomerular capillaries filter? |
|
Definition
| hydrostatic pressure > oncotic pressure |
|
|
Term
| what happens in glomerular capillaries? |
|
Definition
| filtration because hydrostatic pressure > oncotic pressure |
|
|
Term
| why do the peritubular capillaries absorb? |
|
Definition
| oncotic pressure > hydrostatic pressure |
|
|
Term
| what happens in the peritubular capillaries? |
|
Definition
| absorption because oncotic pressure > hydrostatic pressure |
|
|
Term
| how is the afferent arteriole constricted? |
|
Definition
sympathetic nerves
angiotensin II - trivial role |
|
|
Term
| how does the SNS constrict the afferent arteriole? |
|
Definition
| releases NE --> act on a1 receptors --> Gq --> increase Ca --> constriction |
|
|
Term
| what is the effect on GFR of constricting the afferent arteriole? |
|
Definition
|
|
Term
| how is the afferent arteriole dilated? |
|
Definition
renal prostaglandins - PGE2 and PGI2
dopamine
Ca antagonists |
|
|
Term
| what is the effect of aspirin on GFR? |
|
Definition
| decrease because blocks prostaglandins effect at dilating afferent arteriole |
|
|
Term
| what is the effect of dilating the afferent arteriole on GFR? |
|
Definition
|
|
Term
| why would dopamine be a better choice than NE in the ICU? |
|
Definition
| if a patient has compromised renal function DA will increase GFR instead of decreasing it |
|
|
Term
| what constricts the efferent arteriole? |
|
Definition
|
|
Term
| what is the effect on GFR of constricting efferent arteriole? |
|
Definition
increase GFR
even greater if also dilate afferent |
|
|
Term
| what causes dilation of efferent arteriole? |
|
Definition
|
|
Term
| what is the effect on GFR of dilating the efferent arteriole? |
|
Definition
increase GFR
even greater when dilate both efferent and afferent arterioles |
|
|
Term
58 yo COPD patient with HTN and diabetes
2 years since last clinic visit
moved to north dakota for 18 months
inconsistently compliant with meds
no hospitalization but had ED visit in ND for SOB 3 months ago - treated for exacerbation of COPD and had elevated BP
prescribed lisinorpil and hydrocholorothiazide; theophylline was discontinued
moved back to Bayou La Batre
breathing and capacity for exercise are stable
intermittent productive cough of white to yellow sputum - not increased from typical baseline
drinking again and increase in cigarette use
lab results - increase in serum creatinine
what does an increase in serum creatinine indicate? |
|
Definition
|
|
Term
58 yo COPD patient with HTN and diabetes
2 years since last clinic visit
moved to north dakota for 18 months
inconsistently compliant with meds
no hospitalization but had ED visit in ND for SOB 3 months ago - treated for exacerbation of COPD and had elevated BP
prescribed lisinorpil and hydrocholorothiazide; theophylline was discontinued
moved back to Bayou La Batre
breathing and capacity for exercise are stable
intermittent productive cough of white to yellow sputum - not increased from typical baseline
drinking again and increase in cigarette use
lab results - increase in serum creatinine
what may cause a drop in GFR under these circumstances? |
|
Definition
relying on angiotensin II to maintain GFR
fall into acute renal failure with use of ACE inhibitor |
|
|
Term
| what is the effect of GFR with every doubling of serum creatinine? |
|
Definition
|
|
