Massage_connection

Chapter 12—Urinary System 627 Matching the glomeruli may result in albumin in the blood. Glucose is observed in the urine in those a. 11 b. 8 c. 4 d. 3 e. 5 f. 7 g.1 with uncontrolled diabetes mellitus. When the urinary tract is injured or inflamed, blood cells Short-Answer Questions may be detected in the urine. 8. See Figure 12. 7. 1. The ureter conveys urine from the kidney to the 9. Bowman’s capsule—proximal convoluted urinary bladder. tubule—loop of Henle—distal convoluted tubule—collecting duct—renal calyx—renal 2. The urethra conveys urine from the bladder to pelvis—ureter—urinary bladder—urethra. the exterior. In males, it also conveys semen. 10. Urinary tract infection is more common in women because of the short urethra, proximity 3. The micturition reflex results in the emptying of to the anus and vagina, use of tampons, sexual the bladder. Like all nerve reflexes, it has a sen- activity, douches, and use of deodorants, etc. sory component (stimuli—stretch of bladder, 11. Capillary endothelium, basement membrane and impulses conveyed by the sensory nerve); a cen- matrix, visceral layer of the Bowman’s capsule. ter (located in the sacral region); a motor com- ponent (the motor nerve that communicates im- Case Studies pulses from the center to the effector); and effector(s) (detrusor muscle and the external 1. A, James’ blood pressure is high because the and internal sphincter). This reflex is facilitated kidneys secrete renin, which ultimately re- or inhibited by nerves from higher centers lo- sults in the formation of angiotensin II, a cated in the brain. powerful vasoconstrictor and stimulator of aldosterone. Alteration in the secretion of 4. The major effects of massage include an in- this hormone results in blood pressure fluc- crease in urinary volume; an increase in excre- tuation. tion of nitrogenous wastes and ions from the in- terstitial fluid compartment—particularly in B, James has edema because kidney failure af- those individuals with edema. fects excretion of fluids and ions. 5. The fluid in the Bowman’s capsule is an ultrafil- C, Dialysis is a procedure used to remove ni- trate of plasma. The ultrafiltrate is modified by trogenous wastes and ions from the plasma secretion and reabsorption as it flows through and restore it to near normal concentration. the tubules. The fluid in the pelvis is what re- In this procedure, plasma is separated from a mains after all modifications have taken place in fluid that contains nutrients and ions in con- the tubules. centrations similar to normal plasma by a semipermeable membrane. Constituents 6. The reserve capacity of the kidney is decreased. move by diffusion from/to plasma along con- The number of nephrons decreases. Also, the centration gradients across the membrane. tubules decrease in length. Reduction of blood flow also occurs. As a result, kidney function de- D, Diuretics are chemicals that promote urine creases, with slower rate of filtration in the formation. glomeruli and less renin, vitamin D, and ery- thropoietin production. Response to antidiuretic E, James’ blood is likely to contain higher levels hormone is diminished. The regulation of blood of creatinine and urea (normal nitrogenous volume is less efficient, with the ability to con- wastes). The concentration of various ions centrate and dilute the urine diminished. Re- may be different as their excretion is also af- duced vitamin D production affects the absorp- fected in kidney failure. tion of calcium from the intestine (both functions of the hormones). Reduced erythro- F, Massage can increase the excretion of ni- poietin production may contribute to anemia. trogenous wastes and urinary output in The tubular changes result in difficulty main- healthy individuals. In James’ case, the ef- taining acid-base balance. There is reduced ca- fects would be variable, depending on the pacity to excrete drugs. The smooth muscle and functioning of his kidneys. The effect of elastic tissue degenerate with time, replaced touch on any person is difficult to quantify. with fibrous tissue and decreased capacity of the James may, therefore, benefit from a relax- bladder. The muscles become weaker and in- ation massage. complete emptying of bladder may occur. The decrease in bladder capacity results in increased 2. A, and B. Antihypertensive drugs generally have frequency of urination. an effect on the sympathetic nerves, produc- ing vasodilation (and reducing blood pres- 7. Albumin, glucose, and blood cells are three sub- sure). Diuretics may be given, resulting in re- stances not found in normal urine. Damage to

628 The Massage Connection: Anatomy and Physiology breadth superior to the iliac crest. The oblique twelfth rib and the transverse duced blood volume (and blood pressure). processes of L1 and L2 are located posterior When changes occur in posture, the barore- to the kidney. The hilus of the kidney is lo- ceptor reflex rapidly produces generalized cated in the transpyloric plane (a transverse vasoconstriction and increase in blood flow plane at the level of the disk between L1 and to the brain when the effect of gravity tends L2). to pool blood in the lower limbs. Other C, Pain originating in the kidney is felt in the mechanisms include secretion of ADH, aldo- lumbar region (upper back) or radiating to sterone, and reduced secretion of atrial natri- the right or left upper quadrant of the ab- uretic peptide, etc. (see Regulation of Blood domen. Pain from the urinary bladder may Pressure). present just above the pubis or in the upper inner aspect of the thigh. In Mr. Brown’s case, this does not happen 4. A, and B. See answer to V.3. quickly, and he feels dizzy. By sitting up for C, Mr. Logan looses voluntary control as the sometime before getting off the table, Mr. communication is severed from the higher Brown allows sufficient time for his body to centers to the sacral center. Because the mic- compensate for the change in blood pressure. turition reflex pathway is intact, he can uri- C, Kidneys increase blood pressure by secreting nate involuntarily. the hormone renin. Hormones, such as al- 5. A, Tammy has reduced urinary output because dosterone and antidiuretic hormone, regulate the body is trying to compensate for the wa- blood volume and blood pressure by affect- ter (and blood volume) lost through sweating. ing the kidney. B, To conserve water, Tammy’s body secretes 3. A, The components of the urinary system are antidiuretic hormone (ADH) from the poste- the kidney, ureter, urinary bladder, and ure- rior pituitary, which increases water reab- thra. sorption in the distal tubule and collecting B, The kidneys are located retroperitoneally on duct. Aldosterone secretion increases sodium either side of the vertebral column between reabsorption. Water is reabsorbed, along vertebrae T12 and L3. The right kidney is with sodium, by osmosis. These are a few slightly lower than the left because of the mechanisms that help conserve water. In- presence of the liver. On the surface of the creased thirst is another mechanism that body, the superior pole of the kidney is at helps increase blood volume by causing the level T12. The inferior pole lies just above the individual to drink more water. transumbilical plane, the plane at the level of the umbilicus, (i.e., at the upper part of level L3). The inferior pole is, therefore, a fingers-

Chapter 12—Urinary System 629 Coloring Exercise The Position of the Components of the Urinary System. A, Anterior view of the kidneys after removal of the abdominal organs. The contacting areas of neighboring viscera are shown in dotted lines. B, Posterior view of the trunk, showing the location of the kidneys in relation to bone and muscle. C, Trans- verse section of the abdomen at the level of the first lumbar vertebra, superior view.

630 The Massage Connection: Anatomy and Physiology Longitudinal Section Through the Kidney, Near the Hilum

Chapter 12—Urinary System 631 The Structure of a Cortical Nephron and a Juxtamedullary Nephron, Shown in Relation to the Cortex and Medulla nephron nephron

632 The Massage Connection: Anatomy and Physiology Urinary Bladder Innervation and the Micturation Reflex L1 L2 L3 S2 S3 S4