Post on 14-Apr-2018
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FORMASI
URINJABATAN ANATOMI &
FISIOLOGI
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Objektif Am Memahami konsep & proses penghasilan urin
Objektif Khusus Menerangkan proses penghasilan urin
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Proses Penghasilan Urin
- Urin dihasilkan di nefron ginjal
- 3 proses pembentukan urin:
- Penurasan di glomerulus- Penyerapan semula tubul
- Rembesan tubul
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- Berlaku di antara dinding separa telapglomerulus ke Kapsul Bowmans
- Melalui perbezaan tekanan darah di glomerulus& kapsul Bowmans:
- Tekanan hidrostatik di glomerulus tinggi(55mmHg)
- Tekanan osmotik darah (30mmHg)
- Tekanan hidrostatik kapsul Bowmans(15mmHg)
Glomerular Filtration
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55 mmHg
30 mmHg
15 mmHg
55(30 + 15) = 10 mmHg
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- Bahan-bahan yg dituras (filtrate) dr kapilari glomeruluske kapsul Bowmans:
- Air
- Molekul seperti glukosa, urea, kreatinin, asid amino,
uric acid
- Ion Na+, ion K+, ion Cl-
- Bahan-bahan yg kekal dlm kapilari glomerulus:- Sel-sel darah
- Protein plasma
- Molekul besar
Glomerular Filtration
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- Glomerular Filtration Rate (GFR) = isipadu yg
dituras oleh kedua2 ginjal per minit
(125ml/min)- 180 L / day
Hampir semua filtrate reabsorbed
kurang dari 1% (kira-kira 1-1.5 litre) excretedsebagai urine
Glomerular Filtration
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Renal blood flow dikekalkan pada constant pressuredalam julat systolic blood preesure (80200 mmHg)
Autoregulation bertindak independently dari nervous
control Ia merupakan property inherent (ciri yang sedia ada)
dalam renal blood vessel
Ia boleh dirangsang oleh perubahan tekanan darah
dalam renal arteries atau perubahan metabolite,seperti prostaglandins.
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Dalamsevere shock
systolic blood pressure turun kurang dari
80 mmHg
Autoregulation gagal dan renal blood flow
dan hydrostatic pressureberkurang
impair ing f i l trationdalam nephron Keadaan ini dipanggil renal shut down.
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- Proses penyerapan semula bahan-bahan ygdiperlukan oleh tubuh dari renal tubule ke dlm
kapilari darah
- Utk mengekalkan keseimbangan cecair, elektrolit& pH darah.
- Di proximal tubule, loop of Henle, distal tubule
& collecting duct
Selective / Tubular Reabsorption
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- Bahan-bahan yg diserap semula dr tubul ke kapilaridarah:
- Air
- Glukosa, vit larut air- Asid amino
- Na+, Ca2+, Cl-
- Bahan-bahan yg tidak diserap semula:
- Kreatinin
Selective / Tubular Reabsorption
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Penyerapan semula di- proximal tubule: 65% air, Na+, CL-, Ca2+,
glukosa, asid amino, vit larut air
- loop of Henle: 15% air, Na+, K+ & bikarbonat- distal tubule: 10-15 % air, Na+, Cl-
- collecting duct: air, Na+, urea
Selective / Tubular Reabsorption
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- Hormon yang mengawal penyerapan semula tubul:- Antidiuretic Hormon (ADH):
- Mengawalatur isipadu urin > Tingkatkan ketelapan
dinding tubul distal & tubul pengumpul > air
diserap semula ke kapilari darah
- Aldosteron:
- Mengawalatur keseimbangan elektrolit >Tingkatkan penyerapan semula Na+ & sekresi K+
Selective / Tubular Reabsorption
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- Atrial Natriuretic Peptide (ANP):
Kurangkan penyerapan semula air & Na+ di
tubul proksimal & tubul pengumpul.
Rencatkan ADH & aldosteron
- Parathyroid & calcitonin:
- kawalatur Ca2+
Selective / Tubular Reabsorption
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- Rembesan bahan-bahan yg tidak diperlukan &bahan asing dari kapilari darah ke distal
convoluted tubule & collecting duct
Tubular Secretion
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- Bahan yg dirembeskan dr kapilari ke tubul:
- H+
- K+
- Ammonia,
- urea
- Drugs eg penicilin
Tubular Secretion
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Normal urine
volume
1-2 litres/24 hours
per normal adult
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Volume: 1-2 L/ 24 hours
Colour: pale to dark yellow (amber colour)
Clarity: clear
Odor: Slightly odorSpecific gravity: 1.001-1.035
pH: 4.58
Protein: noneGlucose: none
Nitrites: none
Ketones: none
Ciri-ciri Urin Normal
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Komposisi Urin Normal
Water: 96%
Urea: 2%
Uric Acid
CreatinineAmmonia
Sodium
Potassium 2%
Chlorides
Phosphates
Sulphates
Oxalates
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- Albumin:- Normal constituent of plasma. Usually appears in only very
small amounts in urine. Excessive Albumin in urine called
albuminuria; indicates increasing permeabil i ty of membrane
filtrationdue to injur y/disease kidney cells, increased BP
- Glucose:- presence glucose in urine calledglucosuria; indicates diabetis
ABNORMAL URIN COMPOSITION
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- Sel darah merah:- presence RBCs in urine called hematuria; indicates pathological
condition of kidney
- Sel darah putih:- presence WBCs in urine calledpyuria; indicates infection of
urinary organs
ABNORMAL URIN COMPOSITION
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- Ketone bodies:- high level of ketone called ketonuria; indicates diabetis,
anorexia, low CHO diet
- Bilirubin:- RBCs breakdown. high level of bilirubin called bilirubinuria
- Urobilinogen:- breakdown product of hemoglobin. Presence of urobilinogen
called urobilinogenuria; indicates hemolytic anemia, hepatitis
etc
ABNORMAL URIN COMPOSITION
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- Casts:- plug of materials to form tiny tube in kidney. made of RBCs,
WBCs, fatty substances or protein.
- Microbes:- fungus eg Candida albicans, protozoa eg Trichomonas
vaginalis; indicates infection
ABNORMAL URIN COMPOSITION
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Fisiologi Proses Mikturasi
- Mikturasi= pengeluaran urin drp pundi
kencing
- Urination
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volume urine 200 - 400 ml
Stretch ke atas dinding
urinary bladder
1
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Stretch receptordirangsang
Nerve impulse dihantar
melalui pelvic nerve ke
spinal cord bahagian sacral
2
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Nerve impulse dihantar
dari spinal cord ke
cerebral cortex
3
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Apabila keadaan tidak
sesuai untuk pass urine
4
Cerebral cortex menghantar
Impulse inhibition ke spinal cord
(Voluntary inhibition of reflex)
Micturition tidak
berlaku
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Apabila keadaan sesuai
Cerebral cortex menghantar
Impulse ke spinal cord
Impulse dihantar ke external
urinary sphincter &
Detrusor muscle
4
Detrusor muscle contract,
Reflex relaxation of internal
urethral sphincter dan voluntary
relax external urethral sphincter
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Apabila urin dlm pundi kencing> 200-400ml
Tekanan dlm pundi kencing meningkat
Stretch receptor di dinding pundi kencingdirangsang
Impuls dihantar ke spinal cord dan cerebrumimpuls ditaksir di cerebrum
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Impuls dari cerebrum sampai di spinal cord dan
Di pundi kencing, berlaku kontraksi otot detrusor
Reflex relaxation internal urethral sphincter
(involuntary)
relaksasi external urethral sphincter (voluntary)
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Urin di keluarkan daripada pundi kencing
- Pengisian urin yg penuh dlm pundi kencing
merangsang keinginan utk membuang airsebelum reflek mikturasi
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Kawalan Isipadu Urin
- Pengambilan & pengeluaran cecair dikawal
oleh ginjal
- Pengeluaran urin sehari minimum= 500ml/day
- Pengeluaran urin normal sehari= 1-2L/day
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1. Apabila kandungan air dlm badanrendah
(tekanan osmotik darah tinggi)
Posterior pituitari merembeskan Antidiuretic
hormon (ADH)
ADH meningkat & tingkatkan ketelapan dinding
tubul distal & tubul pengumpul
Air diserap semula di tubul distal & tubul
pengumpul ke dlm darah
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Isipadu darah meningkat (tekanan osmotik darah
menurun)
Homeostasis isipadu air dlm badan kekal
Urin pekat & sedikit dihasilkan
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2. Apabila aras Na+ rendah dlm darah, aras K+
tinggi dlm darah & isipadu darah rendah
Aldosteron dirembeskan oleh kelenjar adrenal
Tingkatkan penyerapan semula Na+ bersama-
sama airdari renal tubule ke dalam darah &
sekresi K+ dlm urin
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Homeostasis arasNa+ dan K+ kekal
Isipadu darah meningkat
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3. Apabila kandungan air dlm badan tinggi
(tekanan osmotik darah rendah)
ADH kurang & kurang ketelapan dinding tubul
distal & tubul pengumpul
Air kurang diserap semula di tubul distal & tubul
pengumpul ke dlm darah
Urin cair & banyakdihasilkan
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MCQ
1. Apakah fungsi Bowmans capsule?
A. Mengumpul urin yang dihasilkan
B. Menuras bahan-bahan kumuh dalam darah
C. Merembes bahan-bahan kumuh ke tubul nefron
D. Menyerap semula bahan-bahan yang diperlukan
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2. Yang manakah berikut bukan molekul yang
disingkir keluar dari darah melalui filtration?
A. Glucose
B. Plasma protein
C. Urea
D. Ion potassium
MCQ
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5. Glomerular filtration rate adalah
A. Kadar urinary bladder diisi
B. Amaun filtrate dibentuk di kedua-dua kidney
seminit
C. Amaun filtrate diserap di collecting duct
D. Amaun urine dibentuk sejam
MCQ
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3. pH darah dikawal oleh
A. Angiotensin II
B. Calcitriol
C. Ion hydrogen dari tubular secretion
D. erythropoietin
MCQ
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4. Bahan manakah tidak terdapat dalam
glomerular filtrate yang normal?
A. Cell darah
B. Glucose
C. Amino acids
D. urea
MCQ
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5. Dalam kidney, rangsangan saraf sympathetic
menyebabkan
A. glomerular filtration rate menurun
B. glomerular filtration rate meningkat
C. Urin output meningkat
D. Tekanan filtration meningkat
MCQ
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