Maintenance of the Body
and Clinical Application
Mrs. Bigda, a 60-year-old woman, was brought to the hospital
by the police afer Falling to the pavement. She is Found to have
alcoholic hepatitis. She is put on a salt- and protein-restricted diet
and diuretics are prescribed to manage her ascites (accumulated
ﬂuid in the peritoneal cavity). How will diuretics reduce this
excess ﬂuid? Name and describe the mechanisms oF action oF
three types oF diuretics. Why is her diet salt-restricted?
While repairing a Frayed utility wire, Herbert, an experienced
lineman, slips and Falls to the ground. Medical examination
reveals a Fracture oF his lower spine and transection oF the lumbar
region oF the spinal cord. How will Herbert’s micturition be
controlled From this point on? Will he ever again Feel the need to
void? Will there be dribbling oF urine between voidings? Explain
the reasoning behind all your responses.
What is cystitis? Why do women suﬀer From cystitis more
Frequently than men?
Hattie, aged 55, is awakened by excruciating pain that radiates
From her right abdomen to the loin and groin regions on the
same side. Te pain is not continuous but recurs at intervals oF 3
to 4 minutes. Diagnose her problem, and cite Factors that might
Favor its occurrence.
Why does use oF a spermicide increase a woman’s risk For urinary
Why are renal Failure patients undergoing dialysis at risk For
anemia and osteoporosis? What medications or supplements
could you give them to prevent these problems?
Short Answer Essay Questions
What is the importance oF the perirenal Fat capsule that
surrounds the kidney?
±race the pathway a creatinine molecule takes From a glomerulus
to the urethra. Name every microscopic or gross structure it
passes through on its journey.
Explain the important diﬀerences between blood plasma and
glomerular ﬁltrate, and relate the diﬀerences to the structure oF
the ﬁltration membrane.
Describe the mechanisms that contribute to renal autoregulation.
Describe the mechanisms oF extrinsic regulation oF G²R, and
their physiological role.
Describe what is involved in active and passive tubular
Explain how the peritubular capillaries are adapted For receiving
Explain the process and purpose oF tubular secretion.
How does aldosterone modiFy the chemical composition oF
Explain why the ﬁltrate becomes hypotonic as it ﬂows through
the ascending limb oF the nephron loop. Also explain why the
ﬁltrate at the bend oF the nephron loop (and the interstitial ﬂuid
oF the deep portions oF the medulla) is hypertonic.
How does urinary bladder anatomy support its storage Function?
Deﬁne micturition and describe the micturition reﬂex.
Describe the changes that occur in kidney and bladder anatomy
and physiology in old age.
Related Clinical Terms
Acute glomerulonephritis (GN)
Inﬂammation oF the glomeruli, leading to increased permeability
oF the ﬁltration membrane. In some cases, circulating immune
complexes (antibodies bound to Foreign substances, such as
streptococcal bacteria) become trapped in the glomerular
basement membranes. In other cases, immune responses are
mounted against one’s own kidney tissues, leading to glomerular
damage. In either case, the inﬂammatory response that Follows
damages the ﬁltration membrane, allowing blood proteins and
even blood cells to pass into the renal tubules and into the urine.
As the osmotic pressure oF blood drops, ﬂuid seeps From the
bloodstream into the tissue spaces, causing bodywide edema. Renal
shutdown requiring dialysis may occur temporarily, but normal
renal Function usually returns within a Few months. IF permanent
glomerular damage occurs, chronic GN and ultimately renal Failure
Bladder cancer, three times more common in men
than in women, accounts For about 2% oF all cancer deaths. It
usually involves neoplasms oF the bladder’s lining epithelium and
may be induced by carcinogens From the environment or the
workplace that end up in urine. Smoking, exposure to industrial
chemicals, and arsenic in drinking water also have been linked
to bladder cancer. Blood in the urine is a common warning sign.
a sac, the bladder;
rupture) Herniation oF the urinary bladder into the vagina;
a common result oF tearing oF the pelvic ﬂoor muscles during
Procedure in which a thin viewing tube is threaded into the bladder
through the urethra to examine the bladder’s mucosal surFace.
tasteless, bland) See
Chapter 16, p. 600. Nephrogenic diabetes insipidus is due to lack
oF ADH receptors in the collecting duct.
Intravenous pyelogram (IVP)
written) An X ray oF the kidneys and ureters
obtained afer intravenous injection oF a contrast medium (as
in ²igure 25.18). Allows assessment For obstructions, viewing
renal anatomy (pelvis and calyces), and determining rate oF
excretion oF the contrast medium.
A substance (heavy metal, organic solvent, or bacterial
toxin) that is toxic to the kidneys.
Nocturnal enuresis (NE)
sis) An inability to control
urination at night during sleep; bed-wetting. In children over
6, called primary NE iF control has never been achieved and
secondary NE iF control was achieved and then lost. Secondary
NE ofen has psychological causes. Primary NE is more common
and results From a combination oF inadequate nocturnal ADH
production, unusually sound sleep, or a small bladder capacity.
Synthetic ADH ofen corrects the problem.
AT T H E C L I N I C