THE URINARY SYSTEM & FLUID BALANCE RETROPERITONEAL

THE URINARY SYSTEM:

 Consists of:
o 2 kidneys
o 2 ureters
o Urinary bladder
o Urethra
 Major function: Control the composition and volume of body
fluids

 The kidneys are bean-shaped organs. The size of it is like a

clenched fist, it is the estimated or the approximate size of the
kidneys.
 A connective tissue wherein the renal capsules surrounds each
kidney and around each renal capsule is a thick layer of fat which
protects the kidney from mechanical shock.
 On the medial side of each kidney is the hilum, where the renal
arteries and nerves enter and where the renal vein and ureter
exit the kidney.
 Review of the function of the Urinary System:  The kidney is divided into an outer cortex and an inner medulla,
1. EXCRETION: Remove the waste products from the body. which surrounds the inner sinus.
2. BLOOD VOLUME CONTROL: Regulates the volume of  The bases of several cone-shaped renal pyramids are located at
water removed from the body and to produce urine which the boundary between the cortex and the medulla.
would affect the blood pressure.
3. ION CONCENTRATION REGULATION
4. PH REGULATION: The kidney helps in maintaining the
balance of the pH of the body and it comes second to the
lungs in response to the abnormalities such as acidosis
and alkalosis.
5. RED BLOOD CELL PRODUCTION: In as much as it
produces erythropoietin, which is necessary for RBC
production. So, for patients with kidney disorders such as
chronic kidney disease, these are people with low RBC
count, low hemoglobin count, which is one thing that we
need to monitor amongst patients with renal disorders.
So, for those with CKD (Chronic Kidney Disease), we
inject erythropoietin to them. It is injected subcutaneously  The tip of the renal pyramid extends toward the center of the
in order to facilitate the production of red blood cells. kidney and is surrounded by a calyx
 Calyces are extensions of the renal pelvis, which is the
 The kidneys can suffer from extensive damage but still maintain expanded end of the ureter within the renal sinus.
their extremely important role in the maintenance of homeostasis  The calyces from all renal pyramids would join together to form a
 As long as about 35% of one kidney remains functional — large funnel called the renal pelvis.
survival is possible  The renal pelvis would now become narrow, to form a small tube
 Complete kidney failure = death will ensue if without medical which is called the ureter.
treatment
NEPHRON: FUNCTIONAL UNIT OF THE KIDNEY
FUNCTIONS OF THE URINARY SYSTEM:  Parts of EACH nephron:
(p.s. bagan inulets la hya han naka violet ha igbaw) o Renal corpuscle
 Excrete waste products o Proximal convoluted tubule
 Control blood volume and blood pressure by regulating the o Loop of Henle
volume of urine produced o Distal convoluted tubule
 Regulate the concentration of major ions in the body fluids (e.g.  Filtration membrane is formed by the glomerular capillaries,
Electrolytes such as sodium, potassium, chloride, etc.) basement membrane and podocytes of the Bowman capsule
 Regulate the pH of the extracellular fluid
 Regulate the concentration of the red blood cells in the blood
 Participate (with the skin and liver) in regulating vitamin D
synthesis
ANATOMY OF THE KIDNEY:
BEAN-SHAPED
  Formed where the distal tubules come in contact with the
afferent arterioles next to the Bowman’s Capsule.

URINE PRODUCTION
 Urine is produced by filtration, tubular reabsorption and tubular
secretion
1. FILTRATION
 Renal filtrate passes from the glomerulus into the
Bowman capsule and contain no blood cells and few
blood proteins
 Filtration pressure is responsible for the filtrate formation
 Increased sympathetic activity = decreases blood flow to
the kidney, decreases filtrate formation, and decreases
urine production
 In times of fight and flight response, wherein your sympathetic
activity is increased, then you can say that urine production
decreases during that time because of the decreased blood flow
to the kidney. If there is decreased blood flow to the kidney, there
is decreased filtrate formation.
 Decreased sympathetic activity = has the opposite effect

2. TUBULAR REABSORPTION
 99% of the filtrate volume is reabsorbed by the body; 1%
becomes urine
 That filtrate (99%) contains the water, some of the ions that are
essential and needed by the body.
 Reabsorbed substances: proteins, amino acids, glucose,
fructose, Na+ (Sodium), K+ (Potassium), HCO3-
(Bicarbonate) and Cl- (Chloride).
(P.S. ini na pic nakadto han ppt ni sir pero gin skip la niya so…)  These are ions, electrolytes and substances needed by the body
and so, even if it passes through the kidney, it would not go out
of the glomerulus and be excreted with the urine because these
are reabsorbed.
 65% of the filtrate volume is reabsorbed in the descending
limb of the loop of Henle
 19% is reabsorbed in the distal convoluted tubule and
collecting duct.
 Majority of the reabsorption happens on the descending loop of
Henle.
 For example, in cases where there is too much glucose, just like
in cases of diabetes mellitus, the glucose is reabsorbed. But,
only to the capacity of the renal system. The excess, which is
already beyond the capacity of the renal system would no longer
be absorbed and it would go out and excreted via the urine.
Precisely the reason why, people with diabetes mellitus, you can
see that there is glycosuria or the presence of glucose in the
urine because glucose is already excessive that is already
beyond the absorption capacity of the renal system. But
normally, glucose, protein and amino acids are reabsorbed by
the renal system.

3. TUBULAR SECRETION
 Hydrogen ions, some by-products of metabolism and
some drugs are actively secreted into the nephron.
 Remember that hydrogen ions are also secreted into the
nephron and some of which would be excreted via the urine and
some of it would be buffered.

 RENAL BLOOD SUPPLY:

1. RENAL ARTERIES: Which branch off from the abdominal aorta
and would enter the kidneys.
2. INTERLOBAR ARTERIES: It would pass between the renal
pyramids and would give rise to the arcuate arteries. It also
branches off the arcuate arteries to project into the cortex.
3. AFFERENT ARTERIOLES: Arises from branches of the
interlobular arteries and extend to the glomerular capillaries.
4. EFFERENT ARTERIOLES: Extends from the glomerular
capillaries to the peritubular capillaries.
5. VASA RECTA: Specialized portions of peritubular capillaries
which extends deep into the medulla of the kidney and surrounds
the loop of Henle.
6. The veins on the other hand, runs through parallel of the arteries.
Basically, kun ano an gin again han arteries , it is basically the
same with the renal veins.

 REMEMBER: Juxtaglomerular Apparatus
 o Aldosterone: Increases the rate of active transport on Na+
in the distal convoluted tubules and collecting ducts.
 In other words, in a much simple term, aldosterone would
facilitate the active transport of sodium and remember WHERE
SODIUM IS, WATER WILL FOLLOW, so there would be more
water retention and there would be further increase of BP. In
order to prevent further increase in BP. We give ACE Inhibitors
to the patient. It inhibits the conversion of Angiotensin I to
Angiotensin II which is a potent vasoconstrictor so, BP increase
would be prevented. Remember that this mechanism is activated
in times wherein the patient is having deficient blood volume,
deficient fluid volume and the BP is dropping.

REGULATION OF URINE CONCENTRATION AND VOLUME

 Kidneys maintain the concentration of the body fluids by
increasing water reabsorption from the filtrate when the body
fluid concentration increases ANTIDIURETIC HORMONE MECHANISM
 If the body fluid concentration is increased, meaning, it is  Antidiuretic Hormone
saturated with so much solute, the tendency of the body is to o Secreted by the posterior pituitary gland
reabsorb more water. It is also the capacity to reduce water o Regulates the amount of water reabsorbed by the distal
reabsorption from the filtrate when the body fluid concentration convoluted tubules and collecting ducts (19%)
decreases. Body fluid concentration decreases meaning, there is  Release is regulated by the hypothalamus (Pituitary Gland is
little solute so it would reduce water reabsorption and facilitate under the order of the hypothalamus)
its’ excretion. Now, the volume and composition of the urine  Baroreceptors that monitor blood pressure also influence ADH
would change depending on the conditions of the body. secretion
 Antidiuretic meaning, it prevents diuresis. It prevents excretion of
 Reducing water reabsorption from the filtrate when the body fluid fluid.
concentration decreases  In the antidiuretic hormone, when the ADH level increases, the
 Volume and composition of urine changes, depending on permeability of the water of the distal tubules and the collecting duct
conditions in the body. increases and more water is reabsorbed. So, there is more water
 Urine production also maintains blood volume and therefore retention.
blood pressure  The release of the ADH from the posterior pituitary is regulated by
 If there is much fluid retained in the body, expect that the blood the hypothalamus because certain cells of the hypothalamus are
pressure would also increase. sensitive to the changes in the solute concentration and the
interstitial fluid within the hypothalamus.
 3 major hormonal mechanisms are involved in regulating urine  Meaning, if the body, particularly the hypothalamus senses that the it
concentration and volume: is too much concentrated or there is too much solute, it will release
 Renin-angiotensin-aldosterone (RAA) mechanism more ADH to add more fluid to the solute so that it would not be so
 Antidiuretic hormone (ADH) mechanism much concentrated. The, there will be water retention. So, if there
 Atrial natriuretic hormone (ANH) mechanism will be deficient in ADH, there will be excessive urination, to the
 Each mechanism is activated by different stimuli, but they work extent that the client would suffer from fluid and electrolyte
together to achieve homeostasis imbalance, less concentration in the body “diabetes insipidus”.
 RAA and ANH mechanisms – more sensitive to changes in the
blood pressure. Change in bp would activate these 2
mechanisms.
 ADH – more sensitive to changes in blood concentration. If the
blood is too concentrated, then, it would facilitate retention of
fluid so that it may be diluted somehow.

RENIN-ANGIOTENSIN-ALDOSTERONE MECHANISM
 Renin and angiotensin: help regulate aldosterone secretion
 Renin
o Enzyme secreted by cells of the juxtaglomerular
apparatuses in the kidneys ATRIAL NATRIURETIC HORMONE MECHANISM
o Acts on Angiotensinogen (plasma CHON produced by the  Atrial Natriuretic Hormone
liver)  converts it to Angiotensin I (needed for o Secreted from cardiac muscles in the right atrium of the
conversion to Angiotensin II by ACE)  Angiotensin- heart when blood pressure in the right atrium increases
Converting Enzyme (ACE)  Angiotensin II (potent above normal
vasoconstrictor thereby, it tends to increase the BP.) o Acts on the kidney to decrease Na+ reabsorption (if there
 In cases for example, the client is having deficient blood volume, is decrease in Na+ reabsorption then it also decreases
the RAA is initiated and stimulated. Renin will be converted to water reabsorption thereby decreasing the BP)
Angiotensin I, then Angiotensin I would be converted to
Angiotensin II through ACE and would facilitate vasoconstriction  ANH would be released from the cardiac muscle and it would at
which would further help in increasing the BP. on the kidney, directly on the kidney, to decrease sodium
reabsorption thereby decreasing water reabsorption and also
o Angiotensin II: acts on the adrenal cortex, so that the facilitating a decrease in BP.
adrenal cortex which is found on the top of the kidney,
would secrete aldosterone.  RAA (decreased BP)
 ANH (increased BP)
 o Males: Extends to the end of the penis (approximately 20
cm)
o Females: Shorter (approximately 4 cm) and opens into
the vestibule anterior to the vaginal opening
 The reason why females are more prone to UTI aside from the
close proximity of the rectum to the urethra, the females’ urethra
is shorter as compared to the male. So, if it is shorter, it takes
shorter time for the invading microorganism to ascend and cause
infection and even ascend to the bladder. For male, the urethra
is longer so the microorganisms die because of the inconducive
environment for the survival of the microorganism.

 Internal Urinary Sphincter

o Found at the junction of the urinary bladder and urethra
o Present only in males
o Keeps the semen from entering the bladder during sexual
intercourse and direct the semen to the urethra, out of the
penis.
 This is involuntary.

 External urinary sphincter

o Skeletal muscle that surrounds the urethra as the urethra
extends through the pelvic floor
o Under voluntary control, allowing a person to start or stop
the flow of urine
 Voluntary controlled.
 However, the control of this is not present at birth and it is
learned. That is why there is “toilet training” because you train
yourself to control.

MICTURITION REFLEX
 Activated by stretch of the urinary bladder
 An automatic reflex, but it can be inhibited or stimulated by
higher centers in the brain
 Ability to voluntary inhibit micturition develops at the age of 2-3
years

 Homeostasis is disturbed by the increasing blood pressure and

volume and acts as stimulus to the cardiac muscle cells as the
receptors to facilitate the release of ANP and BNP and it would
result kidneys and blood vessels in response to ANP, there is
increased sodium loss in urine, increased water loss in urine,
reduced thirst, inhibition of ADH, aldosterone, epinephrine and
norepinephrine release. It would now result in decreased bp and
blood volume and homeostasis will be achieved.

URINE MOVEMENT
Anatomy and Histology of the Ureters, Urinary Bladder, and Urethra
 Ureters
o Small tubes that carry urine from the renal pelvis of the
kidney to the posterior inferior portion of the urinary
bladder
 Ureters enter through the inferior posterior portion of the bladder COMPOSITION OF URINE:
because at the anterior inferior portion, the urethra is there. 1. Water - majority
2. Electrolytes – sodium, potassium chloride, bicarbonate,
 Urinary bladder these are the most abundant ions.
o Hollow, muscular container that lies in the pelvic cavity 3. Also contains UREA – your urea is the end product or the
just posterior to the pubic symphysis byproduct of protein metabolism about 25 grams is
o It stores urine (few mL to 1L) produced and excreted by the body.
 Bladder is composed of transitional epithelium that when it is not 4. Creatinine, Phosphates, Sulfates - These 3 are the
full, and it is not distended, it is cuboidal transitional in different products of protein metabolism which is need to be
layers but if stretched, it becomes squamous-like. excreted by the body.
5. Uric Acid is the product of nucleic acid metabolism which
o Trigone: triangle-shaped portion of the urinary bladder also has to be excreted by the body.
located between the opening of the ureters and the
opening of the urethra  As what I have mention to you, your glucose and amino acids
 Urethra are normally filtered because these are large molecules which is
o Tube that carries urine from the urinary bladder to the not supposed to pass normally from the glomerulus. However,
outside of the body
your glucose may appear in the urine if the level of your glucose
 is too high, that the concentration in the glomerular filtrate  Glucose and your protein has the capacity to pull water across
exceeds the capacity of your tubules to absorb it. the glomerulus and the tubules and increased the volume of your
 I discussed it a while ago, pag the level of your glucose exceeds urine which is the explanation why people with diabetes may
beyond the capacity of your tubules to reabsorb it the tendency commonly have POLYURIA. (Kay nag sspillage man an glucose
is that it would fill out and it would be excreted via your urine. ngadto ha urine so an glucose has the capacity to pull out water
Actually, according to study, hindi naman kunting increase lang nga didi kamo sabay kayo sakin sama kayo, so the tendency
ng sugar mo is mag ga’glysuria kana, its not that, actually nag popolyuria an imo pasyente na mayda diabetes) The
according to study, if your blood sugar level reaches about 200 tendency because of polyuria, your patient will experience
mg/dl and above (normal is 120 mg/dl), your blood sugar level, POLYDIPSIA - excessive thirst because of excessive excretion
expect that you will have a glycosuria, or the presence of of fluid from your body.
glucose in your urine. *  URINE SPECIFIC GRAVITY – reflects both the quantity and
 Another is for proteins, traces of protein maybe found but huge miniature of particles (Glucose, Protein, IV contrast agents etc.)
amount of proteins, huge amount of albumin found in your urine Normal Urine Specific Gravity: 1.015 – 1.025. If it is increases,
is already abnormal because these are large molecules which meaning so much of solute and it is too concentrated. It may be
should have been filtered by your glomerulus, so presence of an indicative that the patient is having dehydration.
this large molecule such as protein may indicate damage in the  RENAL CLEARANCE – is most commonly used to evaluate how
glomeruli. * well the kidney functions in terms of excretion.
 If we go to the functions again of renal system, you have there
the ACID SECRETION, so we excrete approximately 70 mEqs of Formula to compute Renal Clearance:
acid each day. So more acid usually needs to be eliminated from
the body that can be excreted directly as free acid in the urine. *
Urine concentration of a substance
 How do we achieve this? How do we achieve excretion of acid? x urine volume∈a giventime
This is accomplished through the renal excretion of acid bound Renal Clearance=
to the so-called CHEMICAL BUFFERS. For example: Your plasma concentration of that substan
hydrogen Ion is secreted by your renal tubular cells into the Example:
filtrate and it is buffered by phosper ions and ammonia, so an  Plasma concentration: .1 ml
imo ammonia is now called ammonium, meaning an ammonia  Urine concentration of a substance: 15 ml
mayda na kasabay or kasalakot na acid hydrogen ions so it  Urine volume in a given time: 1ml/min.
maybe excreted by the body.
15 ml x 1 ml/ min
 Phosphate is present in the glomerular filtrate and ammonia is
Renal Clearance=
produced by the cells of the renal tubules secreted into the
tubular fluid.
.1 ml
 The next one, another function of the renal system is THE ¿=500 ml/ min❑
REGULATION OF ELECTROLYTE SECRETION. So SODIUM,  Meaning, 500 ml of blood are completely cleared from
180 liters of filtrate are formed by the glomeruli each day. 1,100 that particular substance in 1 minute.
grams of this filtrate is SODIUM CHLORIDE and most of it is
reabsorbed. (99% is reabsorbed, only 1% becomes your urine).  *Take note that Few substances are actually completely
If sodium is excreted in excess amount, then the one ingested by cleared from the blood during a single pass through the
the patient, the patient will become dehydrated, meaning an kidney. It takes time for it to be cleared.
excretion of sodium by the urine is more than the intake of the
patient, remember where sodium is, water follows. However, if  Very useful for us is the CREATININE CLEARANCE. Creatinine
less sodium is excreted than Ingested the patient will retain fluid, is a dangerous waste product brought about by protein
meaning gutiay la an na eexcrete na sodium from the body so metabolism. So glomerular filtration maybe assessed through
water will be retained because the rule is where sodium is, the your creatinine clearance. Normal Glomerular filtration rate (GFR
water follows. in Adult: 100-120 ml/min. that’s about 1.67 – 2ml per second).
 ROLE OF ALDOSTERONE: If there is an increased aldosterone  One function of your Urinary System: STORAGE OF URINE IN
meaning more sodium is retained, less is excreted meaning VOIDING. If there is over distention of the bladder due to disease
more water also is reabsorbed. or if there is an increase pressure in the bladder, it may cause
 Another Important electrolyte which is regulated by your Renal reflux, but normally, the urine dire ito ma backflow or dre
system is your POTASSIUM. Concentration of your potassium in magrereflux to the bladder, kay an nafacilitate ito haiya pag flow
the body is regulated by your kidney. It’s the most abundant tikadto didto ha urethra, from the ureter then the bladder then to
intracellular ion. The excretion of your potassium by the kidney is the urethra is your peristaltic movement. Kay ano dire
increased by aldosterone level. Increased Aldosterone secretion nabackflow mayda ba mga sphincter? Wala naman, hindi na
= Increased Potassium excretion. One thing to monitor to siya nagbabackflow because of a unidirectional nature of the
patients with renal diseases and renal failure is THE peristaltic wave, meaning the peristaltic wave is directed to one
RETENTION OF THE POTASSIUM . Remember, retention of the direction meaning its going out. Now in cases were in there is
potassium in the body is life threatening. So people with renal over distention of the bladder because of a disease or there is
disorder sinsasabi ng Doctor na less potassium ang intake mo, increased pressure in the bladder, it may cause a backflow or a
di pwedeng kumain ng masyadong gulay, di pwedeng kumain ng reflux of your urine to the bladder and to the kidney which may
masyadong fruitss because if potassium cannot be excreted lead to a problem, an infection in the kidney which what we call
effectively and efficiently then it may be retained in the body, and pyelonephritis or a damage to the kidney because of the
there will be a buildup of potassium in the body, remember the elevated pressure which is called your Hydronephrosis. In terms
effect of potassium to the heart. So retention of so much of bladder pressure, the first sensation of bladder filling is
potassium in the body could be life threatening. ordinarily felt or occurs when there is already col pwelection of
 Another function of RS: REGULATION OF WATER 100-150 ml of urine. Again your bladder is capable of holding
EXCRETION. Talking about OSMOLALITY. What is Osmolality? about 1 liter of urine, pag abot hin 100-150 ml of urine in the
– Osmolality has been defined as the relative degree of dilution bladder, you get the first sensation of bladder filling then you
and concentration of the urine. Basically, it reflects the number of experience the desire to void if the bladder already contains
particles dissolved ins the urine. Filtrate in the glomerular about 200- 300ml of urine. If it reaches for about 400ml of urine,
capillary, an osmolality with the blood is the same. (An filtrate na there is marked feeling of fullness in the bladder.
nadida ha glomerular capillary, an iya osmolality or kadamo han  I will not discuss to you about the muscle control anymore
solute pareho la han kadamo han solute/osmolality hit imo because I already mentioned to you a while ago your external
blood) And normally it is 300 milliosmoles per liter or 300 urinary sphincter which is under your voluntary control and it is
mmol/L. As filtrate passes to the tubules, to the collecting ducts, innervated by the nerves of the sacral area on the spinal cord,
the osmolality may vary from 50 – 1,200 mmol/L which would kaya nga naman, if the spinal cord in the sacral area is affected
reflect the maximal diluting and concentrating ability of your there will be a problem in terms of muscle control during
kidney. urination or micturition.
 Detrusor Muscle – the bladder smooth muscle. This normally  Water movement is regulated mainly by hydrostatic
would contract to expel or help in expelling your urine. The pressure differences and osmotic differences between the
pressure generated in the bladder is about 50-150 cm. compartments
 Neural Control – contraction of the detrusor muscle or the
smooth muscle in the bladder is regulated by a reflex involving
your PNS or your Parasympathetic nervous system. This reflex is
integrated into the sacral portion of the spinal tract. Your
sympathetic nervous system on the other hand helps in
preventing semen from entering the bladder through the help of
your internal urinary sphincter during ejaculation. If the pelvic
nerves supplying the bladder and the sphincter are destroyed,
the pelvic nerves supplying the bladder and the sphincter are
destroyed, voluntary control and reflex urination are abolished
and the tendency is that the bladder becomes over distended
with urine. The people who meet an accident which involves the
spinal cord sometimes they lose the control already, they lose
the control of urination and micturition the tendency is that they
don’t feel the need to defecate, the bladder simply becomes over
distended. So the tendency, what we do is we insert a catheter.
In cases wherein, the patient can still feel the urge to void we do
the so called bladder training. So an bladder training, this is also REGULATION OF EXTRACELLULAR FLUID COMPOSITION
used for people who have been using a catheter for a prolong  Homeostasis requires that the intake of substances
period of time, na dire na nadidistend an bladder, ngan dire ka
equals their elimination
na nakakafeel an urge because na diretso man pag flow an urine
to the uro bag so gin blabladder training. So an bladder training,  Ingestion = excretion
we clamp the tubing from the catheter to the uro bag there’s a  Total amount of water and electrolytes in the body does
tubing, we clamp it for 4 hours then we release, we allow the not change unless the person is growing, gaining weight,
bladder to distend and for the client to feel the urge to void and or losing weight
then we release for 30 minutes and then we clamp again for o 2 mechanisms help regulate the levels in the ECF:
another 4 hours, nakaindicate naman yun sa Doctor’s order, 1. thirst regulation
nasa chart yan, Do bladder training. 2. Ion concentration regulation
 The spinal pathways from the brain to the urinary system, if this
are the one’s destroyed such in cases wherein there’s a spinal THIRST REGULATION
cord injury reflex contraction of the bladder is maintained but the  Thirst center: group of neurons in the hypothalamus
voluntary control over the process is lost so that becomes a which controls water intake
problem. There is a technique of which measured the tonicity
 Thirst is one of the important means of regulating ECF
and the bladder pressure it’s called your CYSTOMETOGRAM.
volume and concentration
BODY FLUID COMPARTMENTS
- 60% TBW of an adult male and 50% TBW of an adult female “THIRST CASCADE”
consists of water. *In terms of body fluid, total body weight of an Increased blood concentration and decrease in BP
 activates the thirst center and baroreceptors
adult is 60% of water for Male and 50% of water for female,
(aortic arch, carotid sinuses, right atrium)
lesser for female because of adipose tissue. *
 increases water intake
- Water and ions dissolved in the water are distributed in the 2
 reduces blood concentration and increases blood volume
fluid compartments:
1.) Intracellular
- Found within the cells
- 2/3 of the TBW
2.) Extracellular
- Found outside cells, mainly in interstitial fluid, blood plasma and
lymph
- 1/3 of the TBW
- A small portion is separated into sub-compartments: aqueous
humor and vitreous humor of the eye, cerebrospinal fluid,
synovial fluid into the joint cavities, fluid secreted by the glands,
renal filtrate and bladder urine.

*Waray na niya gin discuss from composition of the fluid in the body
chuchu until regulation of acid-base kay gindiscuss na daw ni Sir Mark,
pero gin butang ko la didi kay nakadto kan Sir Andre ppt*

COMPOSITION OF THE FLUID IN THE BODY FLUID

COMPARTMENTS
 Intracellular has a similar composition from cell to cell CONCENTRATION REGULATION
 ICF: contains more K+, Mg2+, PO3-, SO2- and proteins  If ECF composition deviates from its normal range 
compared to the ECF cells cannot control the movement of substances across
 ECF: contains more Na+, Ca2+, Cl- and HCO3- than the the cell membranes or the composition of their ICF 
ICF abnormal cell function/cell death
 Extracellular fluid has a fairly consistent composition from  Normal ECF composition: required to sustain life
one area of the body to another
SODIUM IONS
EXCHANGE BETWEEN BODY FLUID COMPARTMENTS - Dominant extracellular ions
 Cell membranes that separate the body fluid - Recommended intake of Na+: 2.4 gm/day
compartments are selectively permeable - Stimuli that control aldosterone secretion influence the
 Water continually passes between the compartments reabsorption of Na+ from nephrons of the kidneys and the
 Ions in the water do not readily pass through the cell total Na+ in the body fluids
membrane
 - Amount aldosterone = equal amount Na+ reabsorbed diseases, it could be manifested by other ways, not necessarily
may pain na nafefeel. Because pain would occur mostly on
POTASSIUM IONS acute conditions, say for example there is obstruction brought
- Electrically excitable tissues, such as muscles and about by renal calculi, there is sudden distention of the renal
nerves, are highly sensitive to slight changes in the EC capsule, these things can lead to pain.
K+ concentration  KIDNEY PAIN, describe as a dull ache, or a dull pain in
- EC K+ must be maintained within a narrow change for the costovertebral angle or the area formed in the ribcage
these tissues to function normally and vertebral column and may extend to the umbilicus.
- Aldosterone: regulates the concentration of K+ in the  Urethral disorder characterized by Pain in the back –
ECF which radiates to the abdomen, upper thigh to the testes
for males, and into the labia for female. It may be brought
- Aldosterone secretion from the adrenal cortex = K+
about by urethral disorders.
secretion in the kidneys
 Renal colic which causes Flank pain or the pain between
the ribs and ilium – it radiates to the lower abdomen, to
the epigastrium, there is nausea and vomiting, there is
paralytic ileus. It may be brought about by renal colic.
 Bladder Pain / Lower Abdominal Pain – pain in the
suprapubic area. It may be bladder pain. Kay ano may
bladder pain? It may be brought about by distended
bladder or maybe brought about by bladder infection and
bladder inflammation such as your cystitis.
 Another is if you experience Urgency or tenesmus
(painful straining or there may be terminal disurea or pain
after urinating or towards the end of your urination, at the
end of your voiding, it may be usually present in some
conditions.
 Pain in the Urethral meatus – (buho kun diin naagi it ihi) It
may be brought about by urethritis, trauma, foreign body
in the lower urinary tract most especially pag may renal
calculi na nag descend na, irritation of the bladder neck.
 Severe scrotal Pain – severe pain in the scrotal region for
male. It may be brought about by inflammation, edema of
the epididymis or of the testicle itself or torsion of the
testicle.
CALCIUM IONS
 Rectal Fullness – (feeling of fullness in the perineal
- Increases and decreases in the EC concentrations of
area/rectum) For male may indicative of prostatitis or your
Ca2+ have dramatic effects on the electrical properties of prostatic abscess.
excitable tissues  Back leg pain, it may be brought about by metastasis of
- Increased Ca2+ level = decreased activity (inversely the cancer of the prostate to the pelvic bone. *or an
proportional) pagkalat han cancer cells from the prostate to the pelvic
- Parathyroid hormone (PTH) bone.*
 secreted by the parathyroid gland
 increases EC Ca2+ concentration  So this are the things which you need to ask to your client. Ano
 elevated Ca2+ = inhibits PTH secretion and vice an klase han pain na imo naeexperience if there are any. Again
versa as what I have mention a while ago, doesn’t mean that patient
- Vitamin D has a renal disease pain should be present because pain is not
always present in renal problems.
 increases Ca2+ concentration in the blood by
 You also have to ask for the quality of the flow of the urine.
increasing the rate of Ca2+ absorption by the Steady ba an flow, strong ba an flow or bangin kita may dribbling
intestine flow of urine (maihi nanaman, mawara tas maihi nanaman, nag
- Calcitonin uutod utod) because this is an indicative of certain conditions
 secreted by the thyroid gland such as benign prostatic hyperplasia, pag ha lalaki masakit an
 reduces Ca2+ concentration when it is too high penile shaft, indicative of a urethral problem, kun an ha penis, an
 elevated Ca2+ = triggers calcitonin secretion head part an maulol may be an indicative of prostatitis.
 For Kidney disorder it may not be accompanied by pain, makita
PHOSPHATE AND SULFATE IONS ka naal an imo pasyente may ada pedal edema, periorbital
- Reabsorbed by active transport in the kidneys edema because of so much water retention, mayda shortness of
- Rate of reabsorption is slow breath, it ira tun gin yayakan “mapunga punga pag ginahawa”
- If the concentration of these ions in the filtrate exceeds ngay an kay congested na an lungs, mayda changes in urinary
the nephron’s ability to reabsorb them, the excess is
elimination.
excreted in the urine
 You also have to ask your client if there burning sensation
upon urination. Is there discomfort during urination or
REGULATION OF ACID-BASE BALANCE
towards the end of voiding? Is there blood? But again,
 Concentration of H+ in the body fluids is reported as the
blood may not be seen with the naked eye because some
pH
of it could only be be seen under the microscope during
 Body fluid pH: 7.35 – 7.45 urinalysis.
 pH of body fluids is controlled by 3 factors:  Ask for changes in voiding. Because voiding should be
1. Buffers painless. It should be 5-6 times a day. Occasionally once
2. Respiratory system during night time and amount of 1,200-1,500 ml of urine
3. Kidneys in 24 hours.
 When the pH is not properly maintained, the result is  Ask for the frequency of urination
acidosis or alkalosis
 Ask for the urgency or the strong desire to void.
 Ask if there is pain or dysuria during urination.
ASSESSMENT:
 Ask if there is hesitancy in urination (delay and difficulty in
 In terms of assessment, first you asked the client if the client
initiating voiding. It may be brought about by compression
feels pain. Remember that pain is not all present in all renal
of the urethra, neurologic bladder or other obstruction).
  History
………………….
(Hindi pa po done yung ASSESSMENT na part since icontinue pala
niya pagdiscuss this week daw. Thankss)