The document summarizes renal regulation of extracellular fluid volume and composition. The kidneys regulate water, sodium, potassium, and other solute levels through extracellular sensors like baroreceptors and osmoreceptors. Glomerular filtration rate is regulated through myogenic and tubuloglomerular feedback mechanisms. Myogenic feedback involves arteriolar constriction in response to increased blood pressure to maintain filtration. Tubuloglomerular feedback senses distal tubule flow and stimulates arteriolar constriction through paracrine signaling to balance filtration with tubular reabsorption.
Loop of Henle with its complex anatomy and even more complicated physiology has long remained an enigma to researchers all around the world. Here we discuss about the functional anatomy and the transport characteristics of Loop of Henle.
Ayudas para financiar la adquisición de libros de texto dirigidas al alumnado...CEDER Merindades
Bocyl d-26092014-14
Convocatoria ayudas para financiar la adquisición de libros de texto dirigidas al alumnado que curse educación primaria y educación secundaria obligatoria en centros docentes de la Comunidad de Castilla y León, para el curso 2014/2015.
El plazo para la presentación de solicitudes será de quince días naturales a contar desde el siguiente a la publicación de esta orden en el «B.O.C. y L.».
Loop of Henle with its complex anatomy and even more complicated physiology has long remained an enigma to researchers all around the world. Here we discuss about the functional anatomy and the transport characteristics of Loop of Henle.
Ayudas para financiar la adquisición de libros de texto dirigidas al alumnado...CEDER Merindades
Bocyl d-26092014-14
Convocatoria ayudas para financiar la adquisición de libros de texto dirigidas al alumnado que curse educación primaria y educación secundaria obligatoria en centros docentes de la Comunidad de Castilla y León, para el curso 2014/2015.
El plazo para la presentación de solicitudes será de quince días naturales a contar desde el siguiente a la publicación de esta orden en el «B.O.C. y L.».
There are nearly 100 viruses of the herpes group that infect many different animal species.
Official name of herpesviruses that commonly infect human is Humans herpesvirus (HHV)
herpes simplex virus types 1 (HHV 1)
Herpes simplex virus type 2 (HHV 2)
Varicella-zoster virus (HHV 3)
Epstein-Barr virus, (HHV 4)
Cytomegalovirus (HHV 5)
Human herpesvirus 6 (HHV 6)
Human herpesvirus 7 (HHV 7)
Human herpesvirus 8 (HHV 8) (Kaposi's sarcoma-associated herpesvirus).
Herpes B virus of monkeys can also infect humans
hELMINTHS#corona virus#Aspergillosis#BUGANDO#CUHAS#CUHAS#CUHAS#CELL MEMBRANE TRANSPORT#PHYSIOLOGY#BODY FLUIDS#RENAL PHYSIOLOGY#
Fluid distribution and edema
Edema, also spelled œdema, is an abnormal accumulation of fluid in the interstitium, located beneath the skin and in the cavities of the body, which can cause severe pain. Clinically, edema manifests as swelling. The amount of interstitial fluid is determined by the balance of fluid homeostasis; and the increased secretion of fluid into the interstitium, or the impaired removal of the fluid, can cause the condition. The word is from Greek οἴδημα oídēma meaning "swelling".
Hypernatremia and hyponatremia for medical students, tonicity, volume and water disorders including syndrome of inappropriate ADH secretion and diabetes insipidus.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
There are nearly 100 viruses of the herpes group that infect many different animal species.
Official name of herpesviruses that commonly infect human is Humans herpesvirus (HHV)
herpes simplex virus types 1 (HHV 1)
Herpes simplex virus type 2 (HHV 2)
Varicella-zoster virus (HHV 3)
Epstein-Barr virus, (HHV 4)
Cytomegalovirus (HHV 5)
Human herpesvirus 6 (HHV 6)
Human herpesvirus 7 (HHV 7)
Human herpesvirus 8 (HHV 8) (Kaposi's sarcoma-associated herpesvirus).
Herpes B virus of monkeys can also infect humans
hELMINTHS#corona virus#Aspergillosis#BUGANDO#CUHAS#CUHAS#CUHAS#CELL MEMBRANE TRANSPORT#PHYSIOLOGY#BODY FLUIDS#RENAL PHYSIOLOGY#
Fluid distribution and edema
Edema, also spelled œdema, is an abnormal accumulation of fluid in the interstitium, located beneath the skin and in the cavities of the body, which can cause severe pain. Clinically, edema manifests as swelling. The amount of interstitial fluid is determined by the balance of fluid homeostasis; and the increased secretion of fluid into the interstitium, or the impaired removal of the fluid, can cause the condition. The word is from Greek οἴδημα oídēma meaning "swelling".
Hypernatremia and hyponatremia for medical students, tonicity, volume and water disorders including syndrome of inappropriate ADH secretion and diabetes insipidus.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
6. Overview
• What is regulated for
ECF: (outputs)
– water
– Na+
– K+ Text
2
7. Overview
• What is regulated for
ECF: (outputs)
– water
– Na+
– K+ Text
– other solutes (glucose,
amino acids, etc.)
2
8. Overview
• What is regulated for • Sensors for ECF
ECF: (outputs) composition: (inputs)
– water
– Na+
– K+ Text
– other solutes (glucose,
amino acids, etc.)
2
9. Overview
• What is regulated for • Sensors for ECF
ECF: (outputs) composition: (inputs)
– water – baroreceptors
– Na+
– K+ Text
– other solutes (glucose,
amino acids, etc.)
2
10. Overview
• What is regulated for • Sensors for ECF
ECF: (outputs) composition: (inputs)
– water – baroreceptors
– Na+ – volume receptors
– K+ Text
– other solutes (glucose,
amino acids, etc.)
2
11. Overview
• What is regulated for • Sensors for ECF
ECF: (outputs) composition: (inputs)
– water – baroreceptors
– Na+ – volume receptors
– K+ Text – osmoreceptors
– other solutes (glucose,
amino acids, etc.)
2
12. Overview
• What is regulated for • Sensors for ECF
ECF: (outputs) composition: (inputs)
– water – baroreceptors
– Na+ – volume receptors
– K+ Text – osmoreceptors
– other solutes (glucose, – K+
amino acids, etc.)
2
13. Overview
• What is regulated for • Sensors for ECF
ECF: (outputs) composition: (inputs)
– water – baroreceptors
– Na+ – volume receptors
– K+ Text – osmoreceptors
– other solutes (glucose, – K+
amino acids, etc.) – Na+
2
15. As BP goes up, glomerular filtration goes
up 4
16. Keep a list of autoregulation
Autoregulation
5
17. Keep a list of autoregulation
Autoregulation
Apart from neural regulation, there are
2 ways that the kidneys “self-
regulate”.
5
18. Keep a list of autoregulation
Autoregulation
Apart from neural regulation, there are
2 ways that the kidneys “self-
regulate”.
1. myogenic autoregulation –
responses to stretch of the arteriolar
smooth muscle
5
19. Keep a list of autoregulation
Autoregulation
Apart from neural regulation, there are
2 ways that the kidneys “self-
regulate”.
1. myogenic autoregulation –
responses to stretch of the arteriolar
smooth muscle
2. tubuloglomerular autoregulation –
responses to flow through the distal
tubules
5
23. Myogenic autoregulation
• Arteriolar smooth muscle responds to
stretch like other muscles – by
contracting.
• Therefore, ↑ BP ↑ stretch
↑ contraction ↓ filtration pressure
6
24. Myogenic autoregulation
• Arteriolar smooth muscle responds to
stretch like other muscles – by
contracting.
• Therefore, ↑ BP ↑ stretch
↑ contraction ↓ filtration pressure
↓ GFR (constant)
6
25. Myogenic autoregulation
• Arteriolar smooth muscle responds to
stretch like other muscles – by
contracting.
• Therefore, ↑ BP ↑ stretch
↑ contraction ↓ filtration pressure
↓ GFR (constant)
• The reverse, ↓ BP little myogenic
response, because the renal arterioles
are normally nearly completely
relaxed;
6
26. Myogenic autoregulation
• Arteriolar smooth muscle responds to
stretch like other muscles – by
contracting.
• Therefore, ↑ BP ↑ stretch
↑ contraction ↓ filtration pressure
↓ GFR (constant)
• The reverse, ↓ BP little myogenic
response, because the renal arterioles
are normally nearly completely
relaxed;
net effect is ↓ GFR due to ↓ BP directly.
6
29. Tubuloglomerular Feedback
• This effect depends on special
structure – the juxtaglomerular
apparatus.
• macula densa cells of the distal
convoluted tubule (the sensor)
7
30. Tubuloglomerular Feedback
• This effect depends on special
structure – the juxtaglomerular
apparatus.
• macula densa cells of the distal
convoluted tubule (the sensor)
• neighboring juxtaglomerular cells of
the afferent arteriole of the same
nephron (the effector)
7
31. Thousands of nefrons are all regulated to give regular flow.
Increased flow to the glomerulus leads to increased filtration. This
leads to more flow of fluid through the nefron.
Tubuloglomerular (2)
8
32. Thousands of nefrons are all regulated to give regular flow.
Increased flow to the glomerulus leads to increased filtration. This
leads to more flow of fluid through the nefron.
Tubuloglomerular (2)
↑ flow of fluid through the distal
tubule
8
33. Thousands of nefrons are all regulated to give regular flow.
Increased flow to the glomerulus leads to increased filtration. This
leads to more flow of fluid through the nefron.
Tubuloglomerular (2)
↑ flow of fluid through the distal
tubule
stimulation of macula densa cells
8
34. Thousands of nefrons are all regulated to give regular flow.
Increased flow to the glomerulus leads to increased filtration. This
leads to more flow of fluid through the nefron.
Tubuloglomerular (2)
↑ flow of fluid through the distal
tubule
stimulation of macula densa cells
release of paracrine secretions
8
35. Thousands of nefrons are all regulated to give regular flow.
Increased flow to the glomerulus leads to increased filtration. This
leads to more flow of fluid through the nefron.
Tubuloglomerular (2)
↑ flow of fluid through the distal
tubule
stimulation of macula densa cells
release of paracrine secretions
(including NO)
8
36. Thousands of nefrons are all regulated to give regular flow.
Increased flow to the glomerulus leads to increased filtration. This
leads to more flow of fluid through the nefron.
Tubuloglomerular (2)
↑ flow of fluid through the distal
tubule
stimulation of macula densa cells
release of paracrine secretions
(including NO)
The neighboring afferent arteriole cells
respond with ↑ constriction ↓ GFR &
↓ flow
8
37. Thousands of nefrons are all regulated to give regular flow.
Increased flow to the glomerulus leads to increased filtration. This
leads to more flow of fluid through the nefron.
Tubuloglomerular (2)
↑ flow of fluid through the distal
tubule
stimulation of macula densa cells
release of paracrine secretions
(including NO)
The neighboring afferent arteriole cells
respond with ↑ constriction ↓ GFR &
↓ flow
This is a simple negative feedback to
maintain ~ constant flow through the 8
40. Sympathetic nerves
• The sympathetic division of the ANS
innervates both:
– afferent arterioles
9
41. Sympathetic nerves
• The sympathetic division of the ANS
innervates both:
– afferent arterioles
– efferent arterioles
9
42. Sympathetic nerves
• The sympathetic division of the ANS
innervates both:
– afferent arterioles
– efferent arterioles
• α receptors mediate vasoconstriction
in response to sympathetic activity.
9
43. Sympathetic nerves
• The sympathetic division of the ANS
innervates both:
– afferent arterioles
– efferent arterioles
• α receptors mediate vasoconstriction
in response to sympathetic activity.
• The 2 types of arterioles can be
separately controlled.
9
46. Sympathetic nerves (2)
• Vasoconstriction of the afferent
arteriole ↓ blood flow & ↓ GFR
• Constricting the efferent arterioles
↑ filtration pressure & ↑ GFR
10
47. Sympathetic nerves (2)
• Vasoconstriction of the afferent
arteriole ↓ blood flow & ↓ GFR
• Constricting the efferent arterioles
↑ filtration pressure & ↑ GFR
• Most of the important regulation
involves the afferent arterioles.
10
48. Sympathetic nerves (2)
• Vasoconstriction of the afferent
arteriole ↓ blood flow & ↓ GFR
• Constricting the efferent arterioles
↑ filtration pressure & ↑ GFR
• Most of the important regulation
involves the afferent arterioles.
• But a large ↓ in systemic BP strong
sympathetic vasoconstriction ↓
GFR
10
49. Hormonal regulation
mainly, effects on the
movement of specific
substances
11
52. Hormone overview:
• Any hormone that affects average systemic BP
effects on GFR:
especially Ang II
12
53. Hormone overview:
• Any hormone that affects average systemic BP
effects on GFR:
especially Ang II
• 3 hormones selective effects on the kidneys:
12
54. Hormone overview:
• Any hormone that affects average systemic BP
effects on GFR:
especially Ang II
• 3 hormones selective effects on the kidneys:
– antidiuretic hormone (ADH, vasopressin)
12
55. Hormone overview:
• Any hormone that affects average systemic BP
effects on GFR:
especially Ang II
• 3 hormones selective effects on the kidneys:
– antidiuretic hormone (ADH, vasopressin)
regulation of water reabsorption
12
56. Hormone overview:
• Any hormone that affects average systemic BP
effects on GFR:
especially Ang II
• 3 hormones selective effects on the kidneys:
– antidiuretic hormone (ADH, vasopressin)
regulation of water reabsorption
– aldosterone
12
57. Hormone overview:
• Any hormone that affects average systemic BP
effects on GFR:
especially Ang II
• 3 hormones selective effects on the kidneys:
– antidiuretic hormone (ADH, vasopressin)
regulation of water reabsorption
– aldosterone
• ↑ Na+ retention
12
58. Hormone overview:
• Any hormone that affects average systemic BP
effects on GFR:
especially Ang II
• 3 hormones selective effects on the kidneys:
– antidiuretic hormone (ADH, vasopressin)
regulation of water reabsorption
– aldosterone
• ↑ Na+ retention
• ↑ K+ excretion
12
59. Hormone overview:
• Any hormone that affects average systemic BP
effects on GFR:
especially Ang II
• 3 hormones selective effects on the kidneys:
– antidiuretic hormone (ADH, vasopressin)
regulation of water reabsorption
– aldosterone
• ↑ Na+ retention
• ↑ K+ excretion
– atrial natriuretic peptide (ANP) opposite effects to
aldosterone
12
62. Remember diuresis to remember antiduresis
ADH naming
• ADH = anti-diuretic hormone
• diuresis is a condition
13
63. Remember diuresis to remember antiduresis
ADH naming
• ADH = anti-diuretic hormone
• diuresis is a condition
↑ volume of dilute urine
13
64. Remember diuresis to remember antiduresis
ADH naming
• ADH = anti-diuretic hormone
• diuresis is a condition
↑ volume of dilute urine
• ADH at physiological concentrations
prevents diuresis
13
65. Remember diuresis to remember antiduresis
ADH naming
• ADH = anti-diuretic hormone
• diuresis is a condition
↑ volume of dilute urine
• ADH at physiological concentrations
prevents diuresis
• “vasopressin” describes an
“emergency” action at unphysiological
LARGE concentrations of ADH
13
67. ADH mechanism of action
↑ water permeability of collecting
tubules
14
68. ADH mechanism of action
↑ water permeability of collecting
tubules
↑ passive diffusion of water
(“osmosis”) due to the concentration
of NaCl in the ECF of the medulla of
the kidney
14
69. ADH mechanism of action
↑ water permeability of collecting
tubules
↑ passive diffusion of water
(“osmosis”) due to the concentration
of NaCl in the ECF of the medulla of
the kidney
↑ net water reabsorption from
kidneys
↓ osmotic pressure of
plasma and ECF
14
71. Regulation of ADH
• ↑ osmotic pressure “osmoreceptors”
of the hypothalamus with no blood-
brain barrier
15
72. Regulation of ADH
• ↑ osmotic pressure “osmoreceptors”
of the hypothalamus with no blood-
brain barrier
• The osmoreceptors:
15
73. Regulation of ADH
• ↑ osmotic pressure “osmoreceptors”
of the hypothalamus with no blood-
brain barrier
• The osmoreceptors:
are close to the cell bodies that synthesize
ADH
15
74. Regulation of ADH
• ↑ osmotic pressure “osmoreceptors”
of the hypothalamus with no blood-
brain barrier
• The osmoreceptors:
are close to the cell bodies that synthesize
ADH
↑ ADH secretion from pituitary
15
75. Regulation of ADH
• ↑ osmotic pressure “osmoreceptors”
of the hypothalamus with no blood-
brain barrier
• The osmoreceptors:
are close to the cell bodies that synthesize
ADH
↑ ADH secretion from pituitary
• [negative feedback for regulation of
osmotic pressure via a
neurohormone] 15
82. Aldosterone
• Aldosterone acts on cells of the distal
tubules
↑ K+ excretion
↑ Na+ retention
• Aldosterone is secreted by cells of the
adrenal cortex in response to:
18
83. Aldosterone
• Aldosterone acts on cells of the distal
tubules
↑ K+ excretion
↑ Na+ retention
• Aldosterone is secreted by cells of the
adrenal cortex in response to:
↑ [K+] or chronically ↓ [Na+]
18
84. Aldosterone
• Aldosterone acts on cells of the distal
tubules
↑ K+ excretion
↑ Na+ retention
• Aldosterone is secreted by cells of the
adrenal cortex in response to:
↑ [K+] or chronically ↓ [Na+]
↑ Ang II
18
89. Renin-angiotensin system
An example of a regulatory cascade:
Liver Angiotensinogen in blood
plasma
JG cells of afferent arterioles renin
20
90. Renin-angiotensin system
An example of a regulatory cascade:
Liver Angiotensinogen in blood
plasma
JG cells of afferent arterioles renin
Renin cleaves angiotensinogen Ang
I
20
91. Renin-angiotensin system
An example of a regulatory cascade:
Liver Angiotensinogen in blood
plasma
JG cells of afferent arterioles renin
Renin cleaves angiotensinogen Ang
I
Angiotensin converting enzyme (ACE)
from endothelial cells cleaves Ang I
Ang II
20
94. Ang II actions
• Ang II is a powerful vasoconstrictor
– Ang II also “resets” the sensitivity of the
CV regulatory region in the RF of the
medulla
21
95. Ang II actions
• Ang II is a powerful vasoconstrictor
– Ang II also “resets” the sensitivity of the
CV regulatory region in the RF of the
medulla
– both work together ↑ BP
21
96. Ang II actions
• Ang II is a powerful vasoconstrictor
– Ang II also “resets” the sensitivity of the
CV regulatory region in the RF of the
medulla
– both work together ↑ BP
• Ang II stimulates ↑ aldosterone
secretion
21
97. Ang II actions
• Ang II is a powerful vasoconstrictor
– Ang II also “resets” the sensitivity of the
CV regulatory region in the RF of the
medulla
– both work together ↑ BP
• Ang II stimulates ↑ aldosterone
secretion
– ↑ Na+ reabsorption in the distal tubules
21
98. Ang II actions
• Ang II is a powerful vasoconstrictor
– Ang II also “resets” the sensitivity of the
CV regulatory region in the RF of the
medulla
– both work together ↑ BP
• Ang II stimulates ↑ aldosterone
secretion
– ↑ Na+ reabsorption in the distal tubules
– and ↑ K+ excretion
21
99. Ang II actions
• Ang II is a powerful vasoconstrictor
– Ang II also “resets” the sensitivity of the
CV regulatory region in the RF of the
medulla
– both work together ↑ BP
• Ang II stimulates ↑ aldosterone
secretion
– ↑ Na+ reabsorption in the distal tubules
– and ↑ K+ excretion
• Ang II acts in the hypothalamus
thirst 21
112. Maintaining ECF
• Maintenance of the ECF operates on:
– concentrations of electrolytes (& water)
– volume of water in plasma & ECF
25
113. Maintaining ECF
• Maintenance of the ECF operates on:
– concentrations of electrolytes (& water)
– volume of water in plasma & ECF
• Regulation of plasma and ECF
composition depends mainly on:
25
114. Maintaining ECF
• Maintenance of the ECF operates on:
– concentrations of electrolytes (& water)
– volume of water in plasma & ECF
• Regulation of plasma and ECF
composition depends mainly on:
– kidneys
25
115. Maintaining ECF
• Maintenance of the ECF operates on:
– concentrations of electrolytes (& water)
– volume of water in plasma & ECF
• Regulation of plasma and ECF
composition depends mainly on:
– kidneys
– but also, thirst
25
116. Maintaining ECF
• Maintenance of the ECF operates on:
– concentrations of electrolytes (& water)
– volume of water in plasma & ECF
• Regulation of plasma and ECF
composition depends mainly on:
– kidneys
– but also, thirst
• Emergency conditions also involve the
cardiovascular system.
25
119. Regulation involved
• Renal regulation involves a number of
hormonal and paracrine mechanisms,
– and is therefore somewhat slow
(minutes).
26
120. Regulation involved
• Renal regulation involves a number of
hormonal and paracrine mechanisms,
– and is therefore somewhat slow
(minutes).
• Cardiovascular reflexes respond to
some of the same hormones,
26
121. Regulation involved
• Renal regulation involves a number of
hormonal and paracrine mechanisms,
– and is therefore somewhat slow
(minutes).
• Cardiovascular reflexes respond to
some of the same hormones,
– but also are exquisitely responsive to NS
commands;
26
122. Regulation involved
• Renal regulation involves a number of
hormonal and paracrine mechanisms,
– and is therefore somewhat slow
(minutes).
• Cardiovascular reflexes respond to
some of the same hormones,
– but also are exquisitely responsive to NS
commands;
– fast (seconds)
26
126. Shock
• Clinically, shock describes a
condition in which the
cardiovascular system is failing:
– ↓ BP
28
127. Shock
• Clinically, shock describes a
condition in which the
cardiovascular system is failing:
– ↓ BP
– HR often ↑ (especially in hypovolemic)
28
128. Shock
• Clinically, shock describes a
condition in which the
cardiovascular system is failing:
– ↓ BP
– HR often ↑ (especially in hypovolemic)
• It is named by its cause.
(“cardiogenic”, “hypovolemic”, etc.)
28
129. Shock
• Clinically, shock describes a
condition in which the
cardiovascular system is failing:
– ↓ BP
– HR often ↑ (especially in hypovolemic)
• It is named by its cause.
(“cardiogenic”, “hypovolemic”, etc.)
• It can be life threatening because ↓
CO ↓ tissue perfusion and
damage.
28
130. Shock
• Clinically, shock describes a
condition in which the
cardiovascular system is failing:
– ↓ BP
– HR often ↑ (especially in hypovolemic)
• It is named by its cause.
(“cardiogenic”, “hypovolemic”, etc.)
• It can be life threatening because ↓
CO ↓ tissue perfusion and
damage.
28
– dangerous positive feedback