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Elderly Female, hx: Osteoporosis, DM II, Hypertension. Complaint: blood in…

- - - - Muscularis is the middle layer, the inner is longitudinal and the outer is circular smooth muscles. Presence of urine in the renal pelvis stimulates these muscles to contract and send urine down to the Urinary Bladder
      - Adventitia is the External layer made of an array of collagen and elastic fibers within areolar connective tissue. This layer also helps anchor the ureter to the posterior abdominal wall.
      - Mucosa is the Innermost layer with transitional epithelium. It is stretchy and impermeable to urine so it can't leak out. Lamina Propria is external to the transitional epithelium and if part of the ureter is empty the Mucosa folds into the Lumen or center.
    - - The Urinary Bladder has a region known as the Trigone which is on the posterior wall formed by the connecting ureters. This region doesn't move when bladder fills and acts as a funnel to ensure urine runs down towards the Urethra with the bladder contracts.
      - The Bladder also has 4 layers that make up the wall.
        
        Mucosa is the innermost with transitional epithelium to handle the shape changes in stretching, is highly vascular, with mucosal folds or Rugae to allow for more stretch
        
        The Submucosa is dense irregular tissue that supports the bladder wall
        
        Muscularis is 3 layers of smooth muscle collectively referred to as the detrusor muscle. The involuntary urethral sphincter is formed from the smooth muscle that encircles the urethral opening.
        
        Adventitia is the Outermost layer of areolar connective tissue that covers the Urinary Bladder. Peritoneum plus the adventitia forms a serosa on the superior surface.
    - - The Renal Cortex is the outer section is lighter pink and is identified by the Renal Columns
        
        Renal Columns are extensions of the cortex that poke into the renal medulla subdividing the medulla into striated Renal Pyramids.
        
        A Renal Lobe is a renal pyramid and part of the Cortex extending from its base. There are about 8-15 per Kidney
      - The Renal Medulla is darker and divided into pyramids by the renal columns.
        
        The Corticomedullary Junction is where the base of the pyramid meets the Cortex
        
        Renal Papilla are the tips of the pyramid that point towards the Hilum and connects to the minor Calyx
        
        Renal Pyramids are striated and look like rounded triangles
      - The Renal Sinus is medially located in the kidney and is where Urine is "funneled" to be eliminated. The sinus is constructed of progressively larger structures forming the drainage path.
        
        Major Calyces are the points at which the Minor Calyces join leading towards the Renal Pelvis
        
        The Renal Pelvis is a major urine drainage structure that connects to the Ureter.
        
        Minor Calyces get urine from each Renal Papilla
        
        Renal Arteries, Renal Veins, Lymph Vessels, Nerves and some fat are also found in the Renal Sinus
      - The Nephron is the Functional unit of the Kidney that does all of the filtration and consists of 2 structures: Renal Corpuscle and the Renal Tubule.
        
        The Renal Corpuscle is found in the Cortex and is the part that resembles the ball of yarn. It is primarily made of 2 structures: Glomerulus and Glomerular Capsule.
        
        Glomerulus is a tangle of capillaries that the blood enter via the Afferent arteriole and leaves via the Efferent Arteriole.
        
        The blood passes through 2 different arteriole beds that are sites for filtration, reabsorption secretion.
        
        The first bed begins with the Afferent arterioles, enters the Glomerulus, some plasma and other substances are filtered out. the remaining blood leaves the Glomerulus via the Efferent arteriole.
        
        The Efferent arterioles enter the other capillary bed of peritubular capillaries in cortical nephrons or Vasa Recta in Juxtamedullary nephrons.
        
        Peritubular Capillaries intertwine around the proximal and distal Convoluted tubules in the renal cortex.
        
        Vasa Recta are straight vessels that run along the side the Loop of Henle and in the Renal Medulla.
        
        The Glomerular Capsule also known as Bowman's Capsule has two layer and resembles a fist shoved into an inflated balloon. It also has two opposite ends that allow the flow of filtrate.
        
        The Parietal layer is impermeable and made of simple squamous epithelium.
        
        The Vascular "Pole" end is where afferent and efferent vessels attach to the Glomerulus.
        
        Visceral layer is permeable and dirctly covers the capillaries of the Glomerulus.
        
        The Tubular Pole is where the renal tubule begins.
        
        Filtration occurs here because of the differences between the capsular space and glomerular capillaries push out some water and dissolved solutes from the blood as it passes through the capillaries, the fluid that ends up in the capsule is known as filtrate. These freely filtered substances are usually but not restricted to: Water, Glucose, Amino Acids, Ions, some hormones, Vitamins B and C and Ketones
        
        The Renal Tubule the rest of the Nephron that is not the Renal Corpuscle, it contains 3 continuous parts or tubes.
        
        The Nephron Loop or Loop of Henle is the part of the tubule that "dips" into the medullary region and has 2 segments.
        
        Descending Limb has a thick and thin portion, leads from the PCT to the bottom of the loop.
        
        Ascending Limb leads from the bottom of the loop to the Distal Convoluted Tubule. Also has a thick and thin portion.
        
        Distal Convoluted Tubule (DCT) begins where the Loop of Henle ends and extends to the collecting tubule. This is also lined with cuboidal epithelium but with fewer microvilli
        
        The Proximal Convoluted Tubule (PCT) is the first region that extends off from the tubular pole of the Bowman's Capsule. This portion is composed of simple cuboidal epithelium that have microvilli for absorption.
        
        There are 2 types of nephrons that are distinguished by placement and length: Cortical and Juxtamedullary
        
        Cortical Nephrons are roughly 85% of nephrons with the Bowman's Capsule being near the outer part of the Cortex. The Nephron loop is short and barely dips into the medulla.
        
        Juxtamedullary Nephrons are about 15% or the rest of the nephrons present. They lie along the Corticomedullary Junction in the Cortex, have long nephrons that poke deep into the medulla and Establish a salt concentration gradient, allowing urine concentration to be regulated by ADH
        
        Reabsorption is when some substances that have been filtered out end up in the tubular fluid and your body still needs like glucose, amino acids, ions. Diffusion, Osmosis, or Active Transport moves these substances out of the renal tubules, collecting tubules and collecting ducts back into the bloodstream via the Peritubular or Vasa Recta Capillaries. Most water and solutes are absorbed here.
        
        Substances that are regulated by reabsorption include: Sodium, Water, Potassium, Bicarbonate, Calcium. Sodium reabsorption is regulated by two hormones: Aldosterone that stimulates synthesis of sodium/potassium pumps that become embedded in the membrane and allow more sodium to be reabsorbed. Atrial Natriuretic Peptide (ANP) inhibits reabsorption of Sodium in the convoluted tubule and collecting tubules.
        
        Secretion is when Solutes that are moving by active transport out of the blood in the peritubular and vasa recta capillaries and back into the renal tubules, collecting tubules, or collecting ducts. These materials or chemicals are moved back to the tubular fluid to be voided from the body.
        
        There are 3 types of Nitrogenous waste that can be secreted for voiding: Urea that is produced from the breakdown of protein in the liver, Uric Acid produced from the breakdown of Nucleic Acids in the liver, and Creatinine produced from the breakdown of creatine in the muscles. Other wastes could be Drugs like pain killers, or other chemicals like the ones in our food such as artificial sweetener.
    - - Internal Urethral Sphincter is involuntary and superior to the other sphincters. Surrounds the neck of the bladder and controlled by the autonomic nervous system.
      - The differences between the male and female Urethras lie in the fact that one is segmented and is used for more than one body system while the other does not.
        
        Female Urethra only functions to take urine to outside the body with the External Urethral Sphincter located near the External Urethral Orifice in the female peritoneum
        
        The Male Urethra has Urinary and Reproductive functions: to carry urine out and semen out. These cannot happen at the same time. It is also segmented into 3 segments.
        
        Membranous is the shortest section and contains the External Urethral Sphincter
        
        The Spongy or Penile Urethra is the longest part and extends to the external urethral orifice.
        
        Prostatic is the part that travels through the prostate gland.
      - External Urethral Sphincter is inferior to the internal and made of skeletal muscle fibers therefore making it voluntary.
- - - - All 3 of the Conditions perpetuate weakened and damaged blood vessels in the Kidneys causing excess fluid and wastes to build up in her body due to decreased kidney function.
        
        Kidney disease is shown in a few different tests such as urinalysis when RBC are present as well as in blood labs. Creatinine, Urea and Other nitorgenous wastes would be well outside of the homeostatic limits.
        
        This patient would likely need to be put on Dialysis to assist her body in voiding the wastes and excess water.
        
        This patient is not likely to be able to be on dialysis long with all of her other conditions, she will continue to need more and more care until she is no longer able to be mobile or care for her self at all.
  - - - If an infection is contracted the already compromised patient would need to be admitted for close monitoring and IV medications.
- - - - Blood in the urine can be a key sign of the Kidneys beginning to fail