صفحة 4 [ثالث ملف]
( the lymphatic drainage of uterus)

صفحة 2 [ثالث ملف]
(the venous drainage of vas deferens )

📌بالنسبة للبارا باذن الله التفريغ شامل لشرح الدكتورة + ملازم سابقة للدكتورة

ركزوا على السلايدين 👇🏻
الدكتورة شرحتهم بالمعمل واحتمال في الاختبار تجي صور مقاربة لهم

Ova stage of Schistosoma haematobium

Trophozoite of Trichomonas vaginalis

تابع تعديلات في تفريغات الاناتومي 👇🏻

📌#تعديل صفحة 3 في ملف ال genital of male

➡️Internal iliac v

📌#تعديل صفحة 1 في ملف ال genital of male

➡️Sensory: para aortics plexus ( T11_12).

📌#تعديل صفحة 4 في ملف ال genital of female

➡️Prevent prolapse

📌#تعديل صفحة 1 في ملف ال kidney

➡️Perirenal

📌#تعديل صفحة 1 في ملف ال kidney

➡️Mesonephric duct

📌اهم نقاط الفسيو بشكل Notes
للمراجعة او للي ما قراء التفريغات ان شاء الله انها ملمة باهم المعلومات 👇🏻

المعمل الاول فسيو 👇🏻

🏅Golden Notes :

⭐️Factors that effect GFR.
1.Size.
2.Charge .

⭐️Heparan Sulfate: responsible for:
Negative charge of basment membrane.


⭐️The glomerular filtration barrier (GFB) :
1) The fenestrated glomerular endothelium,
2) the glomerular basement membrane (GBM)
3) the podocyte foot processes with slit diaphragms(Nephrin)

⭐️To measure the filtration of 625ml of plasma in glomerulus use PAH acid to abserve its clearance .

⭐️The filtration only occurs to 125ml of plasma and it is reabsorped later in peritubular capillary

⭐️Normal urine output =
0.5 -1 ml (or cc) /[ kg ×hour]
● In Children =1-2 ml(or cc) /[ kg ×hour]


📌Factors affecting the Surface area:
⭐️⬇️  Surface area due to contraction so ⬇️ GFR :
vasopressin , norepinephrine , histamine , thromboxane
⭐️⬆️ Surface area due to relaxation so ⬆️ GFR :
c. AMP , ANP , PGE2 , dopamine

⭐️ macula densa:
chemoreceptor( sensitize to sodium and chloride).

⭐️Juxtaglomerular cell:
modified smooth muscle
[ baroreceptor]



⭐️factors affecting the glomerular capillary hydrostatic pressure:
1- the arterial blood pressure [systemic ] .
2- blood volume .
3- the diameter of the affrent and the effrent arteriole.

⭐️Factors raise glomerular capillary hydroststic pressure :
🔸hypertension
🔸congestive heart failure
🔸preeclampsia

⭐️Factors decrease glomerular capillary hydroststic pressure :
  🔹dehydration
  🔹hypovolemic shock
🔹diarrhea , vomiting, burns


⭐️Factors⬆️hydrostatic pressure in bowman's capsule 👉🏻 ⬇️ GFR :
1-obstruction like stone in Ureter ot tumer.
2- BPH .
3- Stricture in Ureter .
4- Compression from outside like pregnancy .
5- Fibrosis in retroperitoneal.colloid osmotic pressure
لما يزداد colloid عيقلل GFR


⭐️Increase osmotic pressure :
1. dehydration by concentration
2. Multipule myloma

⭐️Decrease osmotic pressure :
1. liver cirosis
2. protein lossing enteropathy
3. starvation
4. nephrotic syndrom


⬆️ C.O.P (dehydration) 👉🏻⬇️ GFR
⬇️ C.O.P (hypoproteinemia)👉🏻 ⬆️ GFR

⭕️In starvation 👉🏻 ⬇️ protein intake 👉🏻⬆️ GFR .
لانه قلل ال Osmotic pressure


⭕️ in high protein intake 👉🏻 ⬆️ amino acid reabsorption with Na 👉🏻 V.D to afferent + V.C to efferent 👉🏻⬆️ GFR
⭐️يعني في النقص الشديد او الزيادة الشديدة للبروتين النتيجة واحدة ⬆️GFR


⭐️Factors effect Capillary filtration Coefficient (Kf) :
1. Permeability
2. Surface area

⭐️GFR= Kf × NFP

⭐️Measurement of GFR :
1⃣ Inulin Clearance [Exogenous]
2⃣ Creatinine Clearance [Endogenous]

⭐️Advantages of using inulin for the test:
1- Freely filtered
2- Not reabsorped or secreted
3- Not metabolized
4- Not stored in kidney
5- Not effect the filtration rate

⭐️Cockcroft-Gault formula:
used to estimate creatinine clearance particularly for dosing renally cleared drugs.
💡It estimates function based on age, weight , serum creatinine ,  biological sex.

📌CrCl=(140-age)×wt / 72 ×Serum creatinine.
الwomen   بيكون 1.4 % 
ال men بيكون 1.23 %

المعمل الثاني فسيو 👇🏻

⭐️ Proximal tubules:
🔶paracellular : passive transport mainly for electrolyte.

🔶Transcellular : active reabsorption may be:
1_ 1ry as Na/ K pump in basolateral membrane.
2_ 2ry as Na/ glucose cotransport in apical membrane .
3_ countr transport as Na/ H pump

📌Hormones work in proximal:
1⃣*angiotensin*  work in countr transport by stimulating (Na/H pump)
2⃣*PTH*👇🏻
Reabsorption of Ca and excret of phosphate.

📌Drugs work on proximal :
1_ *SGLT inhibitors* For diabetic
2_ *Acetazolamide* (diuretic) inhibits carbonic anhydrase  used in:
◻️glaucoma.
◻️Alkalosis
◻️diuretic.

〰〰〰〰〰〰〰〰〰

⭐️ Loop of Henle:

1️⃣descending limb:
reabsorption of water by interstitial hyperosmolarity.

2️⃣ascending limb: contain cotransport of Na / K / 2Cl .

🔅K excretion: channel in
basolateral
apical membranes.

📌Drugs work on Loop of Henle :
• loop diuretics:
by inhibiting the cotransport channel

💡(Bartter Syndrome) occurs in Loop of Henle.

〰〰〰〰〰〰〰〰〰〰
⭐️ Distal tubules:

◼️ Na/Cl symporter in apical membrane.
◼️Ca/Na countr transport in basolateral membrane

📌Drugs work on Distal tubules :
thaizid diuretic
S/E ➡️ hypercalcemia.

(Gitelman Syndrome) occurs in Distal tubules .

〰〰〰〰〰〰〰〰〰
⭐️Collecting duct :

1️⃣principal cell:
📌Hormones work in :
◼️ADH, which increases water reabsorption by inserts aquaporin 2 to the cell membrane on need .

◼️Aldosterone: inserts Na and excret K by channels

2️⃣intercalated cells :
◼️ Aldosterone stimulate 👇🏻
(K/ H countr transport.)


♦️Types of water reabsorption:
1️⃣obligatory : in proximal tubules and loop of henel by following Osmotic gradient.
2️⃣Facultative : in Late part of DCT and collecting duct under hormones stimulation in certain state .

〰〰〰〰〰〰〰〰〰

🔺Bowman capsule: 300mos ( isotonic).

🔺the end of the proximal tubules: isotonic reabsorption

🔺Loop of Henle:
🔹in descending limb:
Water reabsorption due to ⬆️ Osmolarity
🔹In ascending limb:
  NaCl  reabsorption so ⬇️ Osmolarity

🔺distal tubules and collecting duct:
Constant in normal hydration.
Changed in dehydration due to stimulate releasing of ADH.


Concentration of urine by two  mechanism:
◼️osmolarity of interstitium
◼️ADH

📌specific gravity of urine :
measures the density or concentration of solutes in urine
●Important in diagnosis of diabetes insipidus [ Water Deprivation test]