Respiratory SystemRespiratory System

Upper Respiratory Tract

Figure 21.3a

Superior, middle, and inferior Superior, middle, and inferior nasal conchaenasal conchae

Covered with a mucous membrane. Covered with a mucous membrane. Warm and moisten the airWarm and moisten the air Increase the turbulence in the flow of Increase the turbulence in the flow of

air through the nasal cavityair through the nasal cavity Sensory receptors to enhance the Sensory receptors to enhance the

sense of smell.sense of smell. When you have a cold and get extra When you have a cold and get extra

fluid (edema) fluid (edema) runny nose. runny nose.

Nasal ConchaeNasal Conchae A cartilage nasal septum divides the A cartilage nasal septum divides the

right and left sides of the nose.right and left sides of the nose. The nasal conchae contain blood vessels The nasal conchae contain blood vessels

that can dilate, causing the tissue to that can dilate, causing the tissue to swell, closing off one side of your nasal swell, closing off one side of your nasal airway at a time. This allows the closed airway at a time. This allows the closed side to increase its moisture.side to increase its moisture.

Then it will open again and the other Then it will open again and the other side may close. These cycles occur side may close. These cycles occur every eight hours throughout the day.every eight hours throughout the day.

What causes snoring?What causes snoring?

When we are asleep the area at the back When we are asleep the area at the back of the throat sometimes narrows. The of the throat sometimes narrows. The same amount of air passing through this same amount of air passing through this smaller opening can cause turbulence in smaller opening can cause turbulence in the airflow and some vibration of the the airflow and some vibration of the tissues in the nose and mouth. Different tissues in the nose and mouth. Different people who snore have different reasons people who snore have different reasons for the narrowing. The narrowing can be for the narrowing. The narrowing can be in the nose, mouth, or throat. in the nose, mouth, or throat.

SnoringSnoring

Some people cannot breathe through their Some people cannot breathe through their noses because of obstruction of the nasal noses because of obstruction of the nasal passages. This can be caused by a passages. This can be caused by a deviation of the nasal septum, allergies, deviation of the nasal septum, allergies, sinus infections, swelling of the turbinates, sinus infections, swelling of the turbinates, or large adenoids (tonsils in the back of or large adenoids (tonsils in the back of the throat). Many mouth breathers snore, the throat). Many mouth breathers snore, because the flow of air through the mouth because the flow of air through the mouth causes greater vibration of tissues. causes greater vibration of tissues.

SnoringSnoring When we lie on our backs, gravity pulls the When we lie on our backs, gravity pulls the

palate, tonsils, and tongue backwards. This palate, tonsils, and tongue backwards. This often narrows the airway enough to cause often narrows the airway enough to cause turbulence in airflow, tissue vibration, and turbulence in airflow, tissue vibration, and snoring. Frequently, if the snorer is gently snoring. Frequently, if the snorer is gently reminded to roll onto his or her side, the reminded to roll onto his or her side, the tissues are no longer pulled backwards and tissues are no longer pulled backwards and the snoring lessens.the snoring lessens.

Some medications as well as alcohol can Some medications as well as alcohol can lead to enhanced relaxation of muscles lead to enhanced relaxation of muscles during sleep. This will increase snoring.during sleep. This will increase snoring.

ApneaApnea

An apnea is a period of time during which An apnea is a period of time during which breathing stops for 10+ seconds or the breathing stops for 10+ seconds or the breath is 25% less than normal. Apnea is breath is 25% less than normal. Apnea is also a term for blood oxygen levels 4% also a term for blood oxygen levels 4% less than normal.less than normal.

These episodes often occur during sleep.These episodes often occur during sleep. The two types of sleep apnea are Central The two types of sleep apnea are Central

Sleep Apnea and Obstructive Sleep Sleep Apnea and Obstructive Sleep Apnea.Apnea.

PolypsPolyps

Nasal polyps are overgowths of the Nasal polyps are overgowths of the mucosal tissue in the nasal cavities.mucosal tissue in the nasal cavities.

Usually caused from chronic allergiesUsually caused from chronic allergies Can cause difficulty breathing through Can cause difficulty breathing through

nose, loss of smell, headaches.nose, loss of smell, headaches. Treated with steroid sprays or Treated with steroid sprays or

surgery.surgery.

SinusesSinuses The nasal cavity is connected to The nasal cavity is connected to PARANASAL PARANASAL

SINUSES (ETHMOID, SPHENOID, FRONTAL, SINUSES (ETHMOID, SPHENOID, FRONTAL, AND MAXILLARY SINUSES).AND MAXILLARY SINUSES).

They are also lined with the same kind of They are also lined with the same kind of mucosa. mucosa.

When you have a cold, you get stuffed up, and When you have a cold, you get stuffed up, and the pressure can cause sinus headaches.the pressure can cause sinus headaches.

Some people with headaches and sinus pain Some people with headaches and sinus pain assume they have a sinus headache, but the assume they have a sinus headache, but the CT scan shows clear sinuses. They actually CT scan shows clear sinuses. They actually have a problem with cranial nerve V, causing have a problem with cranial nerve V, causing referred pain to the sinuses. They need to see referred pain to the sinuses. They need to see a neurologist.a neurologist.

The Paranasal Sinuses

Figure 7.11a, b

Fig. 23.2b(TE Art)

Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Oropharynx

Nasopharynx

Laryngopharynx

LARYNX

PharynxPharynx1. NASOPHARYNX1. NASOPHARYNX: a continuation of the nasal : a continuation of the nasal

cavity. cavity. The The EUSTACIAN TUBEEUSTACIAN TUBE is located here. is located here.

2. OROPHARYNX2. OROPHARYNX is the back of the mouth; is the back of the mouth; visible when you open your mouth and look all visible when you open your mouth and look all the way back.the way back.

Separating the oropharanyx and the Separating the oropharanyx and the nasopharynx:nasopharynx:

SOFT PALATE: SOFT PALATE: feel it with your tonguefeel it with your tongue UVULAUVULA: located at the end of the soft palate : located at the end of the soft palate The function of the soft palate and uvula is to The function of the soft palate and uvula is to

move upward when swallowing, to prevent food move upward when swallowing, to prevent food from going into nasal cavities. (They don’t close from going into nasal cavities. (They don’t close during vomiting)during vomiting)

3. LARYNGOPHARYNX3. LARYNGOPHARYNX: Can see the vocal cords : Can see the vocal cords here.here.

Pharynx

Figure 21.3a

LARYNXLARYNX

It has two functions:It has two functions: 1. Produce sounds (vocal cords)1. Produce sounds (vocal cords) 2. Prevent food from entering lungs2. Prevent food from entering lungs Made up of nine separate cartilages:Made up of nine separate cartilages: EPIGLOTTISEPIGLOTTIS THYROID CARTILAGETHYROID CARTILAGE CRICOID CARTILAGECRICOID CARTILAGE (2) (2) ARYTENOID CARTILAGESARYTENOID CARTILAGES (4) Smaller cartilages we’re not going to name(4) Smaller cartilages we’re not going to name

Anatomy of the Larynx

Figure 21.5a, b

GLOTTISGLOTTIS is the opening. It stays all the way is the opening. It stays all the way open when you are breathing hard.open when you are breathing hard.

EPIGLOTTIS EPIGLOTTIS flaps over the glottis when you flaps over the glottis when you swallow so nothing will go into the trachea. swallow so nothing will go into the trachea. When you get hiccoughs, it’s from a sudden When you get hiccoughs, it’s from a sudden movement of air into the lungs, so the movement of air into the lungs, so the epiglottis closes to prevent more air from epiglottis closes to prevent more air from going in. It’s unknown why you get hiccoughs. going in. It’s unknown why you get hiccoughs. All the treatments you can try involve All the treatments you can try involve interrupting the normal breathing patterns.interrupting the normal breathing patterns.

Vocal Cords

Figure 21.6

VOCAL CORDS (vocal folds)VOCAL CORDS (vocal folds) Vocal cords are attached to the Vocal cords are attached to the

ARYTENOID CARTILAGESARYTENOID CARTILAGES. If these . If these cartilages move, the vocal cords open. cartilages move, the vocal cords open. When they go back to normal, the When they go back to normal, the glottis will close. The ability to vary glottis will close. The ability to vary the pitch of the voice results from the pitch of the voice results from varying the tension in the vocal folds. varying the tension in the vocal folds.

Vocal CordsVocal Cords

For air to move through, muscles have to For air to move through, muscles have to contract. If muscles here are paralyzed, contract. If muscles here are paralyzed, the airway closes. In surgery, have to the airway closes. In surgery, have to intubate. In an emergency, have to do a intubate. In an emergency, have to do a tracheotomy above the jugular notch. tracheotomy above the jugular notch.

The type of sounds you make depend on The type of sounds you make depend on how far apart the vocal cords are.how far apart the vocal cords are.

Way open = no sound (like when breathing)Way open = no sound (like when breathing) Mostly closed = soundsMostly closed = sounds Men: their thyroid cartilage is larger, so Men: their thyroid cartilage is larger, so

their vocal cords are longer = deeper voice.their vocal cords are longer = deeper voice.

Problems with vocal cordsProblems with vocal cords

LARYNGITISLARYNGITIS: inflamed vocal cords : inflamed vocal cords ((↓ sound production)↓ sound production)

Singers can get Singers can get scar tissue scar tissue nodulesnodules, requires surgery., requires surgery.

FUN FACTSFUN FACTS

What is the Adam's apple and what does it do?What is the Adam's apple and what does it do? It’s really a part of the larynx or voice box. When boys It’s really a part of the larynx or voice box. When boys

go through puberty, hormones cause the larynx to go through puberty, hormones cause the larynx to grow rapidly, deepening their voices and causing the grow rapidly, deepening their voices and causing the bulge to form. Girls' voices also deepen with puberty, bulge to form. Girls' voices also deepen with puberty, but since their larynxes don't tend to grow as much, but since their larynxes don't tend to grow as much, they don't usually develop an "Eve's apple." The they don't usually develop an "Eve's apple." The protrusion is actually composed of thyroid cartilage. protrusion is actually composed of thyroid cartilage. Your larynx is surrounded by a skeleton of cartilage Your larynx is surrounded by a skeleton of cartilage plates that prevents it from collapsing. Some folks plates that prevents it from collapsing. Some folks undergo cosmetic surgery to make it less prominent.undergo cosmetic surgery to make it less prominent.

FUN FACTSFUN FACTS

Definition of Adam's appleDefinition of Adam's apple Adam's apple: Enlargement of the Adam's apple is Adam's apple: Enlargement of the Adam's apple is

considered, like pubic hair growth, one of the considered, like pubic hair growth, one of the secondary sexual characteristics. secondary sexual characteristics.

Origin of the term: It is usually said that Adam's Origin of the term: It is usually said that Adam's apple takes its name from the biblical story about apple takes its name from the biblical story about Adam, Eve. The serpent and the apple. A piece of Adam, Eve. The serpent and the apple. A piece of the forbidden fruit stuck in Adam's throat and the forbidden fruit stuck in Adam's throat and created the anatomic Adam's apple. So the story created the anatomic Adam's apple. So the story goes. However, it may be wrong. Adam's apple in goes. However, it may be wrong. Adam's apple in Latin is "pomum Adami." This may have been a Latin is "pomum Adami." This may have been a mistranslation of the Hebrew "tappuach ha adam" mistranslation of the Hebrew "tappuach ha adam" which also means male bump. Between Latin and which also means male bump. Between Latin and English there's many a slip. English there's many a slip.

FUN FACTSFUN FACTS

Why does your voice sound funny after you Why does your voice sound funny after you inhale helium from a balloon?inhale helium from a balloon?

A healthy 13-year-old boy suffered a cerebral gas A healthy 13-year-old boy suffered a cerebral gas embolism after inhaling helium from a pressurized embolism after inhaling helium from a pressurized tank at a party. A word to the wise: Pressurized, tank at a party. A word to the wise: Pressurized, industrial tanks are not for human consumption! industrial tanks are not for human consumption! Repeated inhalation of helium can hinder your ability Repeated inhalation of helium can hinder your ability to breathe.to breathe.

Helium is an inert gas that is lighter than air. Sound is Helium is an inert gas that is lighter than air. Sound is produced by vibration, the movement of air around produced by vibration, the movement of air around our vocal chords. Because helium gas is lighter than our vocal chords. Because helium gas is lighter than the usual oxygen/nitrogen blend, it changes the the usual oxygen/nitrogen blend, it changes the resonant frequency of the human vocal tract, causing resonant frequency of the human vocal tract, causing a faster vibration and a higher-pitched, cartoon-a faster vibration and a higher-pitched, cartoon-character sound. character sound.

TRACHEATRACHEA

This is a tube that carries air from the This is a tube that carries air from the larynx to the lungs. larynx to the lungs.

It’s fairly rigid from about 16 rings of It’s fairly rigid from about 16 rings of cartilage.cartilage.

The purpose of the cartilage rings is to keep The purpose of the cartilage rings is to keep the trachea open. Otherwise, when you the trachea open. Otherwise, when you inhale, the trachea would collapse like inhale, the trachea would collapse like when you suck hard on a straw. That’s why when you suck hard on a straw. That’s why your vacuum cleaner has rings on the hose.your vacuum cleaner has rings on the hose.

The Trachea

Figure 21.7a

Histology of the tracheaHistology of the trachea

MUCOSA (MUCOSA (Inner, most superficial layer)Inner, most superficial layer) EPITHELIUMEPITHELIUM (pseudostratisfied ciliated (pseudostratisfied ciliated

epithelium) and goblet cells. Function of goblet epithelium) and goblet cells. Function of goblet cells is to produce mucous to trap dirt. Cilia move cells is to produce mucous to trap dirt. Cilia move dirt to larynx dirt to larynx swallowed. swallowed.

LAMINA PROPRIALAMINA PROPRIA (loose connective tissue) with (loose connective tissue) with lots of elastic fibers to make the trachea flexible.lots of elastic fibers to make the trachea flexible.

SUBMUCOSASUBMUCOSA (Deep to the mucosa) This is the (Deep to the mucosa) This is the serous portion to humidify the air.serous portion to humidify the air.

ADVENTITIAADVENTITIA (Deepest layer) This is dense (Deepest layer) This is dense connective tissue with hyaline cartilage.connective tissue with hyaline cartilage.

BRONCHIBRONCHI The trachea branches into the The trachea branches into the RIGHTRIGHT and and LEFT LEFT

BRONCHUSBRONCHUS (the primary bronchi). (the primary bronchi). These branch into the secondary bronchi, which These branch into the secondary bronchi, which

branch into the tertiary bronchi.branch into the tertiary bronchi. The layers become thinner, and the hyaline The layers become thinner, and the hyaline

cartilage no longer has nice rings; just bits.cartilage no longer has nice rings; just bits. The tertiary bronchi are microscopic. The distal The tertiary bronchi are microscopic. The distal

part of the tertiary bronchi are called terminal part of the tertiary bronchi are called terminal bronchioles. These are the last parts of the bronchioles. These are the last parts of the respiratory tree that have smooth muscle and bits respiratory tree that have smooth muscle and bits of hyaline cartilage. Beyond them are the of hyaline cartilage. Beyond them are the respiratory bronchioles.respiratory bronchioles.

If you inadvertently inhale something, which If you inadvertently inhale something, which lung does it go into? Right lung.lung does it go into? Right lung.

Lung cancer occurs slightly more frequently in Lung cancer occurs slightly more frequently in the right lung than in the left lung (about 53% the right lung than in the left lung (about 53% vs. 47% of the time). The most logical vs. 47% of the time). The most logical explanation for this is that the right primary explanation for this is that the right primary bronchus is wider than the left one (and the bronchus is wider than the left one (and the right lung is larger than the left lung), so the right lung is larger than the left lung), so the right lung receives slightly more carcinogenic right lung receives slightly more carcinogenic cigarette smoke with each puff.cigarette smoke with each puff.

The left lung has a cardiac notch; this is where The left lung has a cardiac notch; this is where the heart sits.the heart sits.

The left lung has TWO lobes, but the right lung The left lung has TWO lobes, but the right lung has THREE lobes.has THREE lobes.

Cardiac Notch

Figure 21.8a

Cardiac Notch

Fig. 23.9b(TE Art)

Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Apex

Superior lobe

Middle lobe

Hilum

Inferior Lobe

Secondary bronchi

Pulmonary Ligament

Diaphragmatic surface

Pulmonary veins

Pulmonaryarteries

BRONCHIOLESBRONCHIOLES

(simple columnar epithelium, no cilia, no mucosa) (simple columnar epithelium, no cilia, no mucosa) Surrounding bronchioles are a smooth muscle layer, Surrounding bronchioles are a smooth muscle layer, which functions to direct the flow of air to particular which functions to direct the flow of air to particular portions of the lungs.portions of the lungs.

Right now, only a small percentage of lungs are Right now, only a small percentage of lungs are needed, compared to if you are running.needed, compared to if you are running.

Since there are no cilia, any particle that gets down Since there are no cilia, any particle that gets down that far has to be eaten by macrophages or just stay that far has to be eaten by macrophages or just stay there.there.

In allergic conditions, bronchioles will constrict, In allergic conditions, bronchioles will constrict, blocking air flow to the lungsblocking air flow to the lungs = = ASTHMAASTHMA. . Asthma can also be caused by irritants in the Asthma can also be caused by irritants in the environment, especially by pollution in the city.environment, especially by pollution in the city.

Respiratory BronchiolesRespiratory Bronchioles

Distal to the terminal bronchioles, Distal to the terminal bronchioles, the branches of the respiratory tree the branches of the respiratory tree are now called respiratory are now called respiratory bronchioles.bronchioles.

These end in alveoli (air sacs)These end in alveoli (air sacs)

ALVEOLIALVEOLI

Respiratory bronchioles branch into Respiratory bronchioles branch into TERMINAL BRONCHIOLES TERMINAL BRONCHIOLES (simple (simple cuboidal), which empty into a sack = cuboidal), which empty into a sack = ALVEOLUSALVEOLUS (simple squamous (simple squamous epithelium). epithelium).

This sac is like a balloon surrounded This sac is like a balloon surrounded by a capillary bed. by a capillary bed.

Within the alveoli are macrophages.Within the alveoli are macrophages.

Structures of the Respiratory Zone

Figure 21.9a

Alveoli

Figure 21.10b

Alveoli

Figure 21.10c, d

Partial Pressure of Oxygen Partial Pressure of Oxygen (pO2)(pO2)

The air we breath is a mixture of gasses: primarily nitrogen, The air we breath is a mixture of gasses: primarily nitrogen, oxygen, & carbon dioxide. So, the air you blow into a oxygen, & carbon dioxide. So, the air you blow into a balloon creates pressure that causes the balloon to expand.balloon creates pressure that causes the balloon to expand.

However, the total pressure generated by the air is due in However, the total pressure generated by the air is due in part to nitrogen, in part to oxygen, in part to carbon part to nitrogen, in part to oxygen, in part to carbon dioxide. dioxide.

That part of the total pressure generated by oxygen is the That part of the total pressure generated by oxygen is the 'partial pressure' of oxygen, while that generated by carbon 'partial pressure' of oxygen, while that generated by carbon dioxide is the 'partial pressure' of carbon dioxide. A gas's dioxide is the 'partial pressure' of carbon dioxide. A gas's partial pressure, therefore, is a measure of how much of partial pressure, therefore, is a measure of how much of that gas is present (e.g., in the blood or alveoli).that gas is present (e.g., in the blood or alveoli).

The pO2 of blood therefore refers to the amount of The pO2 of blood therefore refers to the amount of dissolved oxygen in the blood plasma.dissolved oxygen in the blood plasma.

The Respiratory Tree The Respiratory Tree

As the conducting tubes of the respiratory As the conducting tubes of the respiratory tree become smaller, the following tree become smaller, the following changes occurchanges occur Cartilage rings are replaced by irregular Cartilage rings are replaced by irregular

plates of cartilageplates of cartilage Cartilage disappears in the bronchiolesCartilage disappears in the bronchioles The lining epithelium thinsThe lining epithelium thins Elastin remains in the walls Elastin remains in the walls

DIAPHRAGM

• When the diaphragm muscle contracts, the size of the thoracic cavity increases and air rushes into the lungs.

Inspiration

• The diaphragm and the external intercostals are the muscle group that produces inspiration.

FUN FACTSFUN FACTS

Exactly what happens when you get the Exactly what happens when you get the wind knocked out of you?wind knocked out of you?

It’s all about your diaphragm. This dome-It’s all about your diaphragm. This dome-shaped muscle sits below your lungs, and it shaped muscle sits below your lungs, and it helps your windbags inhale and exhale. helps your windbags inhale and exhale. When you get hit in the abdomen, this can When you get hit in the abdomen, this can cause a pressure difference that makes your cause a pressure difference that makes your diaphragm spasm for a few seconds. You diaphragm spasm for a few seconds. You can't catch your breath until the spasm can't catch your breath until the spasm stops.stops.

FUN FACTSFUN FACTS

MYTH: MYTH: Cover your head or catch a Cover your head or catch a cold: Although 90% of the heat lost cold: Although 90% of the heat lost from the body is lost from the head, from the body is lost from the head, covering your head will not prevent covering your head will not prevent this heat loss. The heat is lost from this heat loss. The heat is lost from the warm air that you exhale.the warm air that you exhale.

Lung DamageLung Damage

Smoking destroys cilia, and smoke of any kind Smoking destroys cilia, and smoke of any kind is toxic. Particles in the lungs can’t clear. is toxic. Particles in the lungs can’t clear.

Cigarettes contain tar, which is the same kind Cigarettes contain tar, which is the same kind of tar used to pave roads. of tar used to pave roads.

When there is a thin lining of tar on the alveoli, When there is a thin lining of tar on the alveoli, there is no oxygen exchange to the lungs there. there is no oxygen exchange to the lungs there. Large chunks of the lung become useless. Large chunks of the lung become useless.

Damage to the lungs shows up several ways.Damage to the lungs shows up several ways.

CHRONIC OBSTRUCTIVE CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)PULMONARY DISEASE (COPD)

Number 5 killer in the USA.Number 5 killer in the USA. It is a combination of two conditions:It is a combination of two conditions: CHRONIC BRONCHITISCHRONIC BRONCHITIS: inflammation of the : inflammation of the

bronchi, produces mucous, the openings bronchi, produces mucous, the openings become smaller = obstructed.become smaller = obstructed.

EMPHYSEMAEMPHYSEMA: scarring of elastic tissue on the : scarring of elastic tissue on the bronchioles and alveoli, which collapse now bronchioles and alveoli, which collapse now during exhalation. during exhalation. Characterized by a person with a large, “barrel” Characterized by a person with a large, “barrel”

chest.chest.

Barrel Chest of EmphysemaBarrel Chest of Emphysema

EmphysemaEmphysema

A person with emphysema is like this:A person with emphysema is like this: Inhale all the way, then exhale a little bit, and Inhale all the way, then exhale a little bit, and

hold it. Now inhale and exhale to that same hold it. Now inhale and exhale to that same point.point.

They cannot exhale all the way. They start They cannot exhale all the way. They start using their abdominal muscles, and get a large, using their abdominal muscles, and get a large, barrel chest.barrel chest.

They have chronic acid-base balance problems, They have chronic acid-base balance problems, and the kidneys have to work harder. They and the kidneys have to work harder. They usually develop kidney problems.usually develop kidney problems.

SmokingSmoking

If a person stops smoking after 10 years, If a person stops smoking after 10 years, damage will repair. Longer than 10 years damage will repair. Longer than 10 years may have some residual damage. It takes 7 may have some residual damage. It takes 7 years for lungs to repair. years for lungs to repair.

Smoking right after exercise is worse because Smoking right after exercise is worse because you are breathing more deeply. you are breathing more deeply.

Pollution in the air can also cause particles in Pollution in the air can also cause particles in the lungs, and the ozone can damage the the lungs, and the ozone can damage the lungs. Living in southern California is like lungs. Living in southern California is like smoking one pack a day. smoking one pack a day.

A mother who smokes during pregnancy will A mother who smokes during pregnancy will give birth to a baby with a lower birth weight.give birth to a baby with a lower birth weight.

Smoking Smoking Smoking also is associated with heart Smoking also is associated with heart

disease, cancer of the lung, bladder, disease, cancer of the lung, bladder, and pancreas. and pancreas.

It also causes emphysema, It also causes emphysema, pneumonia, and bronchitis. pneumonia, and bronchitis.

Some people try to quit smoking by Some people try to quit smoking by smoking less, trying not to inhale, or smoking less, trying not to inhale, or switching to chewing tobacco, but switching to chewing tobacco, but there is no safe way to use tobacco.there is no safe way to use tobacco.

PneumoniaPneumonia

An infectious illness that results in An infectious illness that results in the accumulation of fluid in the the accumulation of fluid in the alveoli.alveoli.

Respiratory DisordersRespiratory Disorders

Upper Respiratory Infection (URI)Upper Respiratory Infection (URI) Lungs are not involvedLungs are not involved Usually caused by a cold virus or allergiesUsually caused by a cold virus or allergies Usually not associated with a feverUsually not associated with a fever

Lower Respiratory Infection (LRI)Lower Respiratory Infection (LRI) Lungs are involvedLungs are involved Usually caused by bacteriaUsually caused by bacteria Usually associated with a feverUsually associated with a fever

Other Lung ConditionsOther Lung Conditions

INFLUENZAINFLUENZA LUNG CANCER LUNG CANCER RESPIRATORY DISTRESS RESPIRATORY DISTRESS

SYNDROMESYNDROME SURFACTANTSURFACTANT

PLEURISYPLEURISY PNEUMOTHORAXPNEUMOTHORAX

INFLUENZAINFLUENZA

This is the “flu” caused by a virus. This is the “flu” caused by a virus. This is what you are vaccinated This is what you are vaccinated

against when you get the flu vaccine.against when you get the flu vaccine.

LUNG CANCERLUNG CANCER

There are many types of lung There are many types of lung cancers. About 150,000 die each cancers. About 150,000 die each year from them.year from them.

It is the #1 or #2 most deadly form It is the #1 or #2 most deadly form of cancer.of cancer.

85% of lung cancer is caused from 85% of lung cancer is caused from smoking.smoking.

LUNG CANCERLUNG CANCER

The problem is that it starts as a hard nodule The problem is that it starts as a hard nodule deep in the spongy tissue of the lung, where deep in the spongy tissue of the lung, where it has no symptoms until it presses against a it has no symptoms until it presses against a structure. By then, it has also metastasized. structure. By then, it has also metastasized.

Surgery on a smoker won’t work because the Surgery on a smoker won’t work because the lungs are too weak, and they can’t do lungs are too weak, and they can’t do without the lung tissue. There are no good without the lung tissue. There are no good screening procedures for lung cancer.screening procedures for lung cancer.

In lung cancer, the cancer cells usually arise In lung cancer, the cancer cells usually arise from the epithelium lining a large bronchus.from the epithelium lining a large bronchus.

RESPIRATORY DISTRESS RESPIRATORY DISTRESS SYNDROMESYNDROME

SURFACTANTSURFACTANT is a detergent is a detergent produced within the alveoli, which produced within the alveoli, which coats it. coats it.

It functions to help with lung inflation It functions to help with lung inflation by keeping the walls of the alveoli by keeping the walls of the alveoli from sticking together when they from sticking together when they collapse during exhalation. collapse during exhalation.

If you have two wet pieces of paper If you have two wet pieces of paper and stick them together, they are hard and stick them together, they are hard to pull apart without ripping. Put to pull apart without ripping. Put soapy water between them, and you soapy water between them, and you can pull them apart.can pull them apart.

RESPIRATORY DISTRESS RESPIRATORY DISTRESS SYNDROMESYNDROME

Surfactant is not produced in a fetus until the Surfactant is not produced in a fetus until the ninth month, so premature babies don’t have ninth month, so premature babies don’t have enough surfactantenough surfactant RESPIRATORY RESPIRATORY DISTRESS SYNDROMEDISTRESS SYNDROME, which is the #1 , which is the #1 cause of death in premature babies. cause of death in premature babies.

You know how hard it is to blow up a brand You know how hard it is to blow up a brand new balloon? Imagine a baby having to do new balloon? Imagine a baby having to do that with every single breath. You get tired. that with every single breath. You get tired.

The treatment is to spray artificial surfactant The treatment is to spray artificial surfactant into the lungs, and put them on a respirator into the lungs, and put them on a respirator to push air in. The more distal regions are to push air in. The more distal regions are still collapsed, so there are problems.still collapsed, so there are problems.

PleuraPleura

Lining the thoracic cavity is Lining the thoracic cavity is PARIETAL PARIETAL PLEURAPLEURA..

Lining the lungs is the Lining the lungs is the VISCERAL PLEURAVISCERAL PLEURA.. Both of these are made of 2 layers (simple Both of these are made of 2 layers (simple

squamous epi and loose fibrous ct), same squamous epi and loose fibrous ct), same as the pericardium. Between these pleura as the pericardium. Between these pleura is a tiny space: is a tiny space: PLEURA CAVITYPLEURA CAVITY..

The pleura lubricate the lungs so when the The pleura lubricate the lungs so when the lungs move, it is smooth. They also form lungs move, it is smooth. They also form an airtight seal to allow the lungs to inflate. an airtight seal to allow the lungs to inflate.

Diagram of the Pleural Cavities

Figure 21.11

PLEURISYPLEURISY

The rubbing together of inflamed The rubbing together of inflamed pleural membranes that produces a pleural membranes that produces a stabbing pain in the chest with every stabbing pain in the chest with every breath; it feels like a broken rib. breath; it feels like a broken rib.

Usually the inflammation is caused Usually the inflammation is caused from an infection.from an infection.

It is fairly common.It is fairly common.

BreathingBreathing

When the lungs inflate, the thoracic When the lungs inflate, the thoracic cavity expands for two reasons:cavity expands for two reasons:

The diaphragm pulls down, increases The diaphragm pulls down, increases volumevolume

The rib cage expands, increases volume.The rib cage expands, increases volume. When the diaphragm contracts, the size When the diaphragm contracts, the size

of the thoracic cavity increases, the of the thoracic cavity increases, the pressure inside the thoracic cavity pressure inside the thoracic cavity drops, and air flows into the lungs.drops, and air flows into the lungs.

Changes in Thoracic Volume

Figure 21.15d

PNEUMOTHORAXPNEUMOTHORAX

If there is a hole in the pleura (injury If there is a hole in the pleura (injury from broken rib, knife), it’s like from broken rib, knife), it’s like opening the stopper; air flows in opening the stopper; air flows in through the hole, and the lungs don’t through the hole, and the lungs don’t inflate = inflate = PNEUMOTHORAXPNEUMOTHORAX (air in (air in thorax) thorax) COLLAPSED LUNGCOLLAPSED LUNG..

TUBERCULOSISTUBERCULOSIS

An infection of a really bad bacteria that An infection of a really bad bacteria that get in the lungs and make themselves a get in the lungs and make themselves a capsule to hide in, where antibiotics can’t capsule to hide in, where antibiotics can’t reach. They set up shop in the lungs and reach. They set up shop in the lungs and reproduce. Soon, the lungs fill up with these reproduce. Soon, the lungs fill up with these hard nodes and make it difficult to breathe. hard nodes and make it difficult to breathe. It causes extreme coughing, and then lots It causes extreme coughing, and then lots of these bacteria break off and get spewed of these bacteria break off and get spewed into the air, where someone else can inhale into the air, where someone else can inhale them. It is extremely contagious and very them. It is extremely contagious and very deadly. deadly.

TUBERCULOSISTUBERCULOSIS If a person gets TB, the State Health Department has to be If a person gets TB, the State Health Department has to be

notified.notified. If it is active TB, you must be hospitalized.If it is active TB, you must be hospitalized. If it is not an active infection, you still need medicines.If it is not an active infection, you still need medicines. They will show up at your house every morning for six They will show up at your house every morning for six

months and stand there and watch you take your pills. months and stand there and watch you take your pills. If you don’t accept this, they have the right to haul you If you don’t accept this, they have the right to haul you

away to a lock-up facility and force the medicine in you for away to a lock-up facility and force the medicine in you for six months. six months.

There are only a few diseases where the State Health There are only a few diseases where the State Health Department will step in like this: anthrax, typhoid fever, Department will step in like this: anthrax, typhoid fever, and bubonic plague are other diseases where you don’t get and bubonic plague are other diseases where you don’t get a choice; you are forced into isolation.a choice; you are forced into isolation.

Diseases like TB and the plague have almost wiped out Diseases like TB and the plague have almost wiped out Europe!Europe!

TUBERCULOSISTUBERCULOSIS

A TB test will be positive if you have been A TB test will be positive if you have been exposed to the organism at any point in your life. exposed to the organism at any point in your life.

Then you’ll have to go in for an x-ray to see if it is Then you’ll have to go in for an x-ray to see if it is an active case of TB or not. an active case of TB or not.

Once you recover from TB you will always have a Once you recover from TB you will always have a positive TB test, so tell the nurse that in advance. positive TB test, so tell the nurse that in advance.

You may have to provide documentation that you You may have to provide documentation that you have been treated for it already.have been treated for it already.

Most employers require TB tests before hiring. I Most employers require TB tests before hiring. I had to take one to work here.had to take one to work here.

CYSTIC FIBROSISCYSTIC FIBROSIS

Cystic fibrosis is an inherited disease Cystic fibrosis is an inherited disease that causes thick, sticky mucus to that causes thick, sticky mucus to build up in the lungs and digestive build up in the lungs and digestive tract. It is one of the most common tract. It is one of the most common type of chronic lung disease in type of chronic lung disease in children and young adults, and may children and young adults, and may result in early death.result in early death.

CYSTIC FIBROSISCYSTIC FIBROSIS Millions of Americans carry the defective CF Millions of Americans carry the defective CF

gene, but do not have any symptoms. That's gene, but do not have any symptoms. That's because a person with CF must inherit two because a person with CF must inherit two defective CF genes -- one from each parent. defective CF genes -- one from each parent. An estimated 1 in 29 Caucasian Americans An estimated 1 in 29 Caucasian Americans have the CF gene. The disease is the most have the CF gene. The disease is the most common, deadly, inherited disorder common, deadly, inherited disorder affecting Caucasians in the United States. affecting Caucasians in the United States. It's more common among those of Northern It's more common among those of Northern or Central European descent.or Central European descent.

CYSTIC FIBROSISCYSTIC FIBROSIS

Most children with CF are diagnosed Most children with CF are diagnosed by age 2. A small number, however, by age 2. A small number, however, are not diagnosed until age 18 or are not diagnosed until age 18 or older. These patients usually have a older. These patients usually have a milder form of the disease.milder form of the disease.

RENAL SYSTEMRENAL SYSTEM

Organs of the Renal SystemOrgans of the Renal System KidneysKidneys UretersUreters Urinary Urinary

bladderbladder UrethraUrethra Not many Not many

structures, structures, but very but very important! important!

Figure 23.1a

Functions of Urinary SystemFunctions of Urinary System

Regulate electrolytes (K, Na, etc) Regulate electrolytes (K, Na, etc) Regulate pH in bloodRegulate pH in blood Regulate blood pressureRegulate blood pressure Regulate blood volume (removes Regulate blood volume (removes

excess fluid) excess fluid) Removing metabolic wastesRemoving metabolic wastes

Urea, uric acid, and creatinineUrea, uric acid, and creatinine This is the least important of the kidney’s This is the least important of the kidney’s

functions. You can survive for a few weeks functions. You can survive for a few weeks without excreting waste products in the urine, without excreting waste products in the urine, but hour by hour, the other functions are more but hour by hour, the other functions are more important.important.

Relationship of the Kidneys Relationship of the Kidneys to Vertebra and Ribsto Vertebra and Ribs

Figure 23.1b

They are retroperitoneal and are located in the

abdominal cavity.

They are at the level of T12 to L3, so they are at the costal margin, and the ribs protect them a little.

Even though they are protected by thoracic ribs, they are NOT in the thoracic cavity because they are below the diaphragm.

STRUCTURES WITHIN THE STRUCTURES WITHIN THE KIDNEYKIDNEY

The The RENAL CAPSULE RENAL CAPSULE surrounds the kidney, surrounds the kidney, dense fibrous connective tissue.dense fibrous connective tissue.

A layer of adipose tissue surrounds the A layer of adipose tissue surrounds the capsule, called capsule, called PARARENAL FAT PARARENAL FAT (ADIPOSE). (ADIPOSE). It cushions and protects. It cushions and protects.

Around that is a connective tissue layer = Around that is a connective tissue layer = RENAL FASCIARENAL FASCIA, made of loose connective , made of loose connective tissue. It anchors the kidney to the tissue. It anchors the kidney to the surrounding peritoneum and abdominal wall. surrounding peritoneum and abdominal wall. Not very strong. Jumping up and down can Not very strong. Jumping up and down can cause tearing.cause tearing.

Position of the Kidneys with Position of the Kidneys with in the Posterior Abdominal in the Posterior Abdominal

WallWall

Figure 23.2a

Gross Anatomy of the Gross Anatomy of the KidneysKidneys

Renal cortex (Most superficial layer) Renal cortex (Most superficial layer) Renal medulla Renal medulla

Renal pyramids (drain into the calyx) Renal pyramids (drain into the calyx) Renal pelvis Renal pelvis

Calyx (drains into hylus Calyx (drains into hylus ureter) ureter)

UreterUreter

Arcuate arteries

Interlobular arteries

Interlobar arteries

Renal fascia

Internal Anatomy of the Internal Anatomy of the KidneysKidneys

Figure 23.3b

Interlobar artery

Blood Supply to KidneyBlood Supply to Kidney

AORTA AORTA RENAL ARTERY RENAL ARTERY SEGMENTAL ARTERIES SEGMENTAL ARTERIES INTERLOBAR ARTERIES INTERLOBAR ARTERIES ARCUATE ARTERIES ARCUATE ARTERIES (form (form arcs) arcs) INTERLOBULAR ARTERIESINTERLOBULAR ARTERIES

INTERLOBULAR VEIN INTERLOBULAR VEIN ARCUATE VEIN ARCUATE VEIN INTERLOBAR INTERLOBAR VEINS VEINS SEGMENTAL VEINS SEGMENTAL VEINS RENAL VEIN RENAL VEIN INF. INF. VENA CAVAVENA CAVA

Summary of Blood Vessels Summary of Blood Vessels Supplying the KidneySupplying the Kidney

Figure 23.10

Internal Anatomy of the Internal Anatomy of the KidneysKidneys

Figure 23.3b

Interlobar artery

Microscopic Anatomy of the Microscopic Anatomy of the KidneysKidneys

Just like the unit of function of the Just like the unit of function of the lungs is the alveolus, the unit of lungs is the alveolus, the unit of function of the kidney is the function of the kidney is the NEPHRONNEPHRON. .

Each kidney has about 100,000 Each kidney has about 100,000 nephrons.nephrons.

They carry out all of the various They carry out all of the various functions of the kidneys.functions of the kidneys.

Microscopic Anatomy of the Microscopic Anatomy of the NephronNephron

GLOMERUS WITH A CAPSULEGLOMERUS WITH A CAPSULE PROXIMAL CONVOLUTED TUBULEPROXIMAL CONVOLUTED TUBULE LOOP OF HENLELOOP OF HENLE

DESCENDING LIMBDESCENDING LIMB Thick portionThick portion Thin portionThin portion

ASCENDING LIMBASCENDING LIMB Thick portionThick portion Thin portionThin portion

DISTAL CONVOLUTED TUBULEDISTAL CONVOLUTED TUBULE COLLECTING DUCTCOLLECTING DUCT

NephroNephronn

Position of Nephron in Position of Nephron in KidneyKidney

Figure 23.4a

Glomerulus of a NephronGlomerulus of a Nephron

JUXTAGLOMERULAR JUXTAGLOMERULAR APPARATUSAPPARATUS

The juxtaglomerular apparatus (JGA) consists of The juxtaglomerular apparatus (JGA) consists of cells located in and around the glomerulus and cells located in and around the glomerulus and the glomerular capsule.the glomerular capsule.

The glomerulus is the first part of the nephron, The glomerulus is the first part of the nephron, where the filtration occurs. where the filtration occurs.

The glomeruli are located only in the renal cortex. The glomeruli are located only in the renal cortex. A glomerulus (“ball of yarn”) is a tuft of capillaries A glomerulus (“ball of yarn”) is a tuft of capillaries

surrounded by a glomerular capsule (Bowman’s surrounded by a glomerular capsule (Bowman’s capsule) made of simple squamous epithelium. capsule) made of simple squamous epithelium. The glomerulus fits in the capsule like a fist The glomerulus fits in the capsule like a fist punched into an underinflated balloon. punched into an underinflated balloon.

The capsule collects the plasma from the The capsule collects the plasma from the arterioles and drains it into the convoluted arterioles and drains it into the convoluted tubules, which empty into a collecting duct, which tubules, which empty into a collecting duct, which exits the body. exits the body.

The plasma is further filtered along the way. The plasma is further filtered along the way.

GlomeruluGlomerulus of a s of a

NephronNephron

Normally at the end of the capillary bed you Normally at the end of the capillary bed you have venuoles. But this is the only part of the have venuoles. But this is the only part of the body that is different: here we have another body that is different: here we have another arteriole, called the arteriole, called the EFFERENT ARTERIOLEEFFERENT ARTERIOLE, , which takes blood away from the glomerulus. which takes blood away from the glomerulus.

The efferent arteriole drops down straight, The efferent arteriole drops down straight, next to the Loop of Henle. While it is straight, next to the Loop of Henle. While it is straight, it is called it is called VASA RECTA (straight VASA RECTA (straight capillaries). capillaries).

There are capillaries that come off the There are capillaries that come off the efferent arteriole efferent arteriole which surround the loop which surround the loop of Henle. Here, they are called peritubular of Henle. Here, they are called peritubular capillaries. They then leave the area to capillaries. They then leave the area to become the interlobular vein, which leaves become the interlobular vein, which leaves the kidney.the kidney.

NephroNephronn

Efferent arterioleAfferent arterioleGlomerulus

FUNCTION OF THE FUNCTION OF THE NEPHRONNEPHRON

Blood comes in from theBlood comes in from the AFFERENT ARTERIOLES. AFFERENT ARTERIOLES. Plasma leaks out and enters the glomerular capsule. Plasma leaks out and enters the glomerular capsule.

The plasma contains nutrients, waste products, etc. The plasma contains nutrients, waste products, etc. As the plasma moves through the proximal As the plasma moves through the proximal convoluted tubule, all of the nutrients, and most of convoluted tubule, all of the nutrients, and most of the water, and most of the ions are absorbed back the water, and most of the ions are absorbed back out of the nephrons and into the blood.out of the nephrons and into the blood.

In the Loop of Henle, almost all of the rest of the In the Loop of Henle, almost all of the rest of the water and salt are removed water and salt are removed blood. blood.

Everything that is not reabsorbed (the waste Everything that is not reabsorbed (the waste products) goes into the collecting duct and is products) goes into the collecting duct and is excreted as urine.excreted as urine. This is also how the water-salt This is also how the water-salt balance is maintained, as well as the acid-base balance is maintained, as well as the acid-base balance. balance.

NephroNephronn

FUNCTION OF THE FUNCTION OF THE NEPHRONNEPHRON

In the distal convoluted tubule, the rest of the In the distal convoluted tubule, the rest of the water and salt are removed.water and salt are removed.

The rest of the liquid goes into the collecting The rest of the liquid goes into the collecting duct.duct.

The distal convoluted tubule and the The distal convoluted tubule and the collecting duct fine-tune the water and salt collecting duct fine-tune the water and salt absorption and excretion. If you are well absorption and excretion. If you are well hydrated, the water will be allowed to leave hydrated, the water will be allowed to leave urine.urine.

If you are thirsty, the water will be absorbed. If you are thirsty, the water will be absorbed. The purpose of the capillary bed is to absorb The purpose of the capillary bed is to absorb these things from the nephron into the blood.these things from the nephron into the blood.

Figure 23.5

Renal Corpuscle and the Renal Corpuscle and the Filtration MembraneFiltration Membrane

Figure 23.6c

DiureticsDiuretics Diuretics are medicines that increase the Diuretics are medicines that increase the

amount of urine that is produced. amount of urine that is produced. People who have high blood pressure People who have high blood pressure

might be prescribed diuretics to decrease might be prescribed diuretics to decrease the blood volume. the blood volume.

Alcohol is a diuretic and this is what Alcohol is a diuretic and this is what contributes to the symptoms of a contributes to the symptoms of a hangover. The best way to prevent a hangover. The best way to prevent a hangover after drinking is to consume hangover after drinking is to consume a lot of water before you go to bed. a lot of water before you go to bed.

Caffeine is also a diuretic, so coffee Caffeine is also a diuretic, so coffee and regular Coca-cola are diuretics.and regular Coca-cola are diuretics.

HISTOLOGY OF THE HISTOLOGY OF THE NEPHRONNEPHRON

PROXIMAL AND DISTAL PROXIMAL AND DISTAL CONVOLUTED TUBULESCONVOLUTED TUBULES This area absorbs nutrients, water, and This area absorbs nutrients, water, and

salt. Only about 1% of the fluid filtered salt. Only about 1% of the fluid filtered by the kidney actually becomes urine.by the kidney actually becomes urine.

LOOP OF HENLELOOP OF HENLE This is where you get diffusion of water. This is where you get diffusion of water.

It is located in the renal medulla.It is located in the renal medulla.

Urine ProductionUrine Production

Filtration – filtrate of blood leaves Filtration – filtrate of blood leaves kidney capillarieskidney capillaries

Reabsorption – most nutrients, water, Reabsorption – most nutrients, water, and essential ions reclaimedand essential ions reclaimed

Secretion – active process of Secretion – active process of removing undesirable moleculesremoving undesirable molecules

Figure 23.9a

Collecting Duct (tubule)Collecting Duct (tubule)

Receives urine from distal Receives urine from distal convoluted tubules, empties into convoluted tubules, empties into ureter.ureter.

Figure 23.4a

Kidney ProblemsKidney Problems

Things can happen to the kidney: infection, Things can happen to the kidney: infection, excess proteins, pH change, blood pressure excess proteins, pH change, blood pressure drops, and can lead to kidney failure. drops, and can lead to kidney failure.

Treatment is Treatment is DIALYSISDIALYSIS, which removes blood, , which removes blood, send it through a filter, and return it without send it through a filter, and return it without the wastes. Done three times a week. Ideally, the wastes. Done three times a week. Ideally, need a kidney transplant because the kidney need a kidney transplant because the kidney has other functions as well.has other functions as well.

The brain, heart, and kidney are the only three The brain, heart, and kidney are the only three organs in the body that have to get oxygen to organs in the body that have to get oxygen to sustain life.sustain life.

UretersUreters These are long tubes that connect the These are long tubes that connect the

renal pelvis to the urinary bladderrenal pelvis to the urinary bladder

MUCOSAMUCOSA TRANSITIONAL EPITHELIUM (for expansion)TRANSITIONAL EPITHELIUM (for expansion) LAMINA PROPRIA (has elastic tissue to LAMINA PROPRIA (has elastic tissue to

recoil)recoil) MUSCULAR LAYER (smooth muscle)MUSCULAR LAYER (smooth muscle)

INNER CIRCULARINNER CIRCULAR OUTER LONGITUDINALOUTER LONGITUDINAL

ADVENTITIAADVENTITIA Provides protection, strength for organs, Provides protection, strength for organs,

and attaches ureters to surrounding and attaches ureters to surrounding structuresstructures

URINARY BLADDERURINARY BLADDER The structure is identical to ureter The structure is identical to ureter

except mucosal layer has folds = except mucosal layer has folds = RUGAE which allow for expansion. RUGAE which allow for expansion.

The mucosal folds in the bladder The mucosal folds in the bladder (rugae) have the same basic function (rugae) have the same basic function as transitional epithelium—as transitional epithelium—accommodating stretch as the bladder accommodating stretch as the bladder fills.fills.

You can hold up to one liter of urine, You can hold up to one liter of urine, although at 500ml, you’ll be dancing. although at 500ml, you’ll be dancing.

Urinary BladderUrinary Bladder

Rugae: allows Rugae: allows for expansionfor expansion

-A full bladder is -A full bladder is roughly the size of roughly the size of a soft balla soft ball

Figure 23.14

URINARY BLADDERURINARY BLADDER

At the base of the urinary bladder, At the base of the urinary bladder, the muscle layer is thicker and is the muscle layer is thicker and is called the DETRUSOR MUSCLE, which called the DETRUSOR MUSCLE, which allows emptying of the urinary allows emptying of the urinary bladder. bladder.

The function of the urinary bladder is The function of the urinary bladder is just to store urine.just to store urine.

Detrusor MuscleDetrusor Muscle

URETER entrance to URETER entrance to BLADDERBLADDER

The The URETERURETER comes in at the base of comes in at the base of the urinary bladder, not the top. the urinary bladder, not the top.

As the bladder fills, it presses down As the bladder fills, it presses down on the ureters to prevent urine from on the ureters to prevent urine from backing up into the kidneys. backing up into the kidneys.

BLADDERBLADDER

The The TRIGONETRIGONE is a triangular area where the ureters is a triangular area where the ureters come in and the urethra goes out. come in and the urethra goes out.

Between the urethra and the urinary bladder are two Between the urethra and the urinary bladder are two sphincters:sphincters:

INTERNAL URETHRAL SPHINCTERINTERNAL URETHRAL SPHINCTER: smooth muscle: smooth muscle EXTERNAL URETHRAL SPHINCTEREXTERNAL URETHRAL SPHINCTER: skeletal muscle. : skeletal muscle.

Although it is primarily under voluntary control, it will Although it is primarily under voluntary control, it will contract if the urine volume is too much.contract if the urine volume is too much.

If the patient is in a coma or under anesthesia for a If the patient is in a coma or under anesthesia for a long time, the internal sphincter will be closed, like long time, the internal sphincter will be closed, like when you are asleep, so a catheter is needed to open it when you are asleep, so a catheter is needed to open it to drain the urine out. to drain the urine out.

UrethraUrethra

Drains the urine to the outside. Drains the urine to the outside. Its histology is the same as the Its histology is the same as the

ureterureter Females: 4cmFemales: 4cm Males 20 cm (varies with mood)Males 20 cm (varies with mood) Therefore, women (esp. little Therefore, women (esp. little

girls) are more susceptible togirls) are more susceptible to UTIUTI..

ProblemsProblems

URETHRITISURETHRITIS = infection and = infection and inflammation of the urethrainflammation of the urethra

CYSTITISCYSTITIS = infection of the urinary = infection of the urinary bladder.bladder.

UREAUREA

Urea is a waste product of amino acid Urea is a waste product of amino acid metabolism. metabolism.

Remember, proteins are made of amino Remember, proteins are made of amino acids, so when you break down acids, so when you break down proteins, you break down amino acids, proteins, you break down amino acids, and the waste product left over is urea. and the waste product left over is urea.

This is the main waste product in urine.This is the main waste product in urine.

COLOR OF URINECOLOR OF URINE

When you urinate, it should be mostly When you urinate, it should be mostly clear with almost no yellow color. clear with almost no yellow color.

The more yellow the urine is, the The more yellow the urine is, the more dehydrated you are. more dehydrated you are.

If the urine is very dark yellow, you If the urine is very dark yellow, you are burning too much protein (as in are burning too much protein (as in food deprivation). This is often seen in food deprivation). This is often seen in diabetes.diabetes.

ProblemsProblems

KIDNEY STONESKIDNEY STONES Develop in the renal pelvisDevelop in the renal pelvis Stones are made out of a variety of Stones are made out of a variety of

things: uric acid, calcium, etc.things: uric acid, calcium, etc. They keep growing.They keep growing.

KIDNEY STONESKIDNEY STONES

They can block the ureter, causing the kidney They can block the ureter, causing the kidney to enlarge. As the kidney stretches, the capsule to enlarge. As the kidney stretches, the capsule stretches, causing excruciating pain in cycles of stretches, causing excruciating pain in cycles of hours. As pressure builds up around the stone, hours. As pressure builds up around the stone, urine can pass, and the kidney stone moves urine can pass, and the kidney stone moves down the urethra slowly.down the urethra slowly.

Symptomatic kidney stones are pea sized or Symptomatic kidney stones are pea sized or larger (up to 1 ½ inches).larger (up to 1 ½ inches).

They get stuck in three places:They get stuck in three places: Renal pelvisRenal pelvis In the ureter as it bends over the common iliac In the ureter as it bends over the common iliac

arteryartery In the urinary bladder at the trigone.In the urinary bladder at the trigone.

Kidney stones get stuck in three Kidney stones get stuck in three places:places:

Renal pelvisRenal pelvis In the ureter as it bends over the In the ureter as it bends over the

common iliac arterycommon iliac artery In the urinary bladder at the trigone.In the urinary bladder at the trigone.

Where Where kidney kidney

stones get stones get stuckstuck

Ureter

Urinary bladder trigone

Common iliac artery

Renal pelvis

KIDNEY STONES TREATMENTKIDNEY STONES TREATMENT ULTRASOUND LITHOTRIPSYULTRASOUND LITHOTRIPSY

Put a powerful speaker on the outside of the Put a powerful speaker on the outside of the kidney, sends a shock wave which the tissues kidney, sends a shock wave which the tissues absorb, but the stones shatter so the pieces absorb, but the stones shatter so the pieces can pass easier. can pass easier.

STENTSTENT (1 ½ foot long tube) in to keep the ureter open (1 ½ foot long tube) in to keep the ureter open

along its entire length. Insert under general along its entire length. Insert under general anesthetic, remove without. anesthetic, remove without.

To help prevent kidney stones, drink To help prevent kidney stones, drink enough fluid so your urine stays clear and enough fluid so your urine stays clear and light colored.light colored.

Other Kidney ProblemsOther Kidney Problems

Pyelitis: infection of the renal pelvis and Pyelitis: infection of the renal pelvis and calycescalyces

Nephritis: inflammation of the nephrons.Nephritis: inflammation of the nephrons. Hydronephritis: excess fluid in the Hydronephritis: excess fluid in the

nephron.nephron. Cystitis: inflammation of the urinary Cystitis: inflammation of the urinary

bladder.bladder. Glucose in the urine: indicates diabetes.Glucose in the urine: indicates diabetes.