CHAPTER TWENTY-THREE

The Digestive System

23.1 Overview of the Digestive System

A. The digestive system consists of a muscular tube called the gastrointestinal tract (or GI tract) and a variety
of accessory organs.
1. Gastrointestinal tract – the muscular tube through which food passes. The GI tract, also known as
the alimentary canal, begins with the mouth and continues through the oral cavity, pharynx,
esophagus, stomach, small intestine, and large intestine which opens to the exterior through the
anus.
2. Accessory organs – along the length of the GI tract, several accessory structures produce secretions
containing water, enzymes, buffers and other components that assist in preparing organic and
inorganic nutrients for absorption. The primary accessory organs include: salivary glands, liver,
gallbladder, and pancreas.
3. The digestive system works with other systems to support tissues that have no direct connection to
the outside environment and no other means to obtain nutrients.
B. Histology - The organs of the GI tract have distinctive structural and functional characteristics, but all share
an underlying pattern of histological organization. There are four basic layers of the muscular tube:
1. Mucosa – the innermost lining containing the mucous membrane of epithelial tissue supported by a
basement membrane and thin layer of muscle tissue.
a. Epithelium = the epithelium varies according to location within the GI tract
i. Stratified squamous epithelium – found in the oral cavity, pharynx, the upper
portions of the esophagus, and rectum.
ii. Simple columnar epithelium – found within the lower portions of the esophagus,
the stomach, small intestine, and most of the large intestine. Possess numerous
goblet cells (mucous producing cells).
b. Lamina propria = a basement membrane composed of areolar connective tissue. Contains
blood vessels, sensory nerve endings, lymphatic vessels, scattered areas of lymphoid tissue
(recall Peyer’s patches and MALT), and mucous glands.
c. Muscularis mucosae = two concentric layers of smooth muscle. The inner layer encircles
the lumen (circular layer) and the outer layer runs parallel to the long axis of the GI tract
(longitudinal layer). Contractions of the muscles within the muscularis mucosae create the
folds that project from the internal surface of the GI tract such as rugae, plicae circularis,
and villi.
2. Submucosa – a layer of dense irregular connective tissue surrounding the mucosa. Contains large
blood vessels, lymphatic vessels, nerves, and in some regions, exocrine glands that secrete enzymes
and buffers into the lumen of the GI tract.
3. Muscularis externa – dominated by smooth muscle oriented in two layers: an inner circular layer
and an outer longitudinal layer. These layers are essential in the mechanical processing of food and
the propulsion of food through the digestive tract.
a. Smooth muscle cells are relatively long and slender, ranging from 5 to 10 µm in diameter
and 30 to 200 µm in length.
b. Although actin and myosin filaments are utilized in the contraction of smooth muscle, they
arranged differently from that of skeletal and cardiac muscle. There are no sarcomeres or
myofibrils. As a result, there are no striations in smooth muscle and is called unstriated
muscle.
c. Thin fibers (actin) are attached to dense bodies rather than Z lines and thick filaments
(myosin) have more heads per thick filament and are scattered throughout the sarcoplasm.
d. Furthermore, there are no T-tubules and the sarcoplasmic reticulum (SR) forms a loose
network throughout the sarcoplasm.
 e. Visceral smooth muscle cells have no direct contact with motor neurons but are connected to
each other by gap junctions so whenever a contraction is stimulated, its electrical signal can
spread from cell to cell. Pacesetter cells are present in areas where peristalsis, or rhythmic
contraction, is necessary.
C. Innervation. Intrinsic innervation of much of the alimentary canal is provided by the enteric nervous
system, which are grouped into two plexuses:
1. The myenteric plexus (plexus of Auerbach) lies in the muscularis layer of the alimentary canal and
is responsible for motility, especially the rhythm and force of the contractions of the muscularis.
2. The submucosal plexus (plexus of Meissner) lies in the submucosal layer and is responsible for
regulating digestive secretions and reacting to the presence of food
D. Blood supply. The blood vessels serving the digestive system have two functions.
1. They transport the protein and carbohydrate nutrients absorbed by mucosal cells after food is
digested in the lumen. Lipids are absorbed via lacteals, tiny structures of the lymphatic system.
2. The blood vessels’ second function is to supply the organs of the alimentary canal with the nutrients
and oxygen needed to drive their cellular processes.
E. The Peritoneum. Along most portions of the organs in the peritoneal cavity, the muscularis externa is
covered by a layer of visceral peritoneum called the serosa. There is no serosa covering the organs of the
oral cavity, pharynx, or esophagus. Instead, a dense network of collagen fibers forms a sheath called the
adventitia to anchor the organs to the surrounding tissues. In the abdominal cavity, the serosa often pulls
away from the surface of the organs to create 5 major peritoneal folds:
a. Greater omentum - apron-like structure that lies superficial to the small intestine and transverse
colon; a site of fat deposition in people who are overweight
b. Falciform ligament - anchors the liver to the anterior abdominal wall and inferior border of the
diaphragm
c. Lesser omentum - suspends the stomach from the inferior border of the liver; provides a pathway
for structures connecting to the liver
d. Mesentery - vertical band of tissue anterior to the lumbar vertebrae and anchoring all of the small
intestine except the initial portion (the duodenum)
e. Mesocolon - attaches two portions of the large intestine (the transverse and sigmoid colon) to the
posterior abdominal wall

23.2 Digestive System Processes and Regulation:

A. Digestive System Functions
1. Ingestion - occurs when foods and beverages enter the digestive tract via the mouth.
2. Mechanical processing - chewing, mixing of food with saliva, churning of food in the stomach and
segmentation in the intestine.
3. Propulsion - movement of food through the alimentary canal by swallowing and peristalsis.
4. Chemical digestion - the chemical and enzymatic breakdown of foods into small organic molecules
that can be absorbed such as carbohydrates, proteins and lipids.
5. Secretion - emission of water, enzyme, buffers, and acids into the lumen.
6. Absorption - movement of small organic end products and other important molecules (such as
water, electrolytes, carbohydrates, proteins, lipids, nucleic acids, vitamins, and minerals like Fe or
Ca) from the lumen of the GI tract into the interstitial fluids, blood, or lymph.
7. Compaction - the progressive dehydration of indigestible materials and organic wastes prior to
elimination from the body. The compacted materials are called feces and the elimination of feces
via the anus is called defecation.
B. Digestive Processes
1. Neural control. The walls of the alimentary canal contain a variety of sensors that help regulate
digestive functions. These include mechanoreceptors, chemoreceptors, and osmoreceptors, which
are capable of detecting mechanical, chemical, and osmotic stimuli, respectively.
2. Hormonal control. A variety of hormones are involved in the digestive process.
 a. The main digestive hormone is gastrin - is secreted by the stomach in response to the
presence of food. Gastrin stimulates the secretion of gastric acid by the parietal cells of the
stomach mucosa.
b. secretin - produced by the duodenum stimulates a watery secretion of bicarbonate by the
pancreas
c. cholecystokinin (CCK) - stimulates the secretion of pancreatic enzymes and bile from the
liver and release of bile from the gallbladder
d. gastric inhibitory peptide (GIP) - inhibits gastric secretion and slows gastric emptying and
motility.

23.3 The Mouth, Pharynx and Esophagus (Upper GI tract)

A. Mouth – lined with non-keratinized stratified squamous; produces the bolus
1. The anterior and lateral borders of the oral cavity is formed by:
a. Labia - or lips, possess no sweat glands or sebaceous glands. Distinguished by the red
margin and the orbicularis oris muscle. A superior and inferior labial frenulum attaches
the lips to the gums.
b. Cheeks - formed by the buccinator muscles.
c. Vestibule - area bounded by the lips and cheeks externally and internally by the gingivae
(gums) and teeth.
2. The superior boundary of the oral cavity (or roof) is formed by:
a. Hard palate - composed of the palatine process of the maxilla and the palatine bones.
b. Soft palate - the soft palate is composed of muscle tissue rather than bone.
3. The posterior boundary of the oral cavity is formed by:
a. Uvula - composed of connective and reticular tissue; helps to prevent food from entering the
oropharynx prematurely and houses WBCs.
b. Palatine tonsils - lie on either side of the oral cavity in the archways called the fauces.
c. Root of the tongue - the fixed portion of the tongue that enters into the oropharynx.
Differentiated from the body of the tongue by the v-shaped circumvallate papillae.
Possesses the lingual tonsils.
4. The inferior boundary (or floor) of the oral cavity is formed by:
a. Body of the tongue - anterior, mobile portion of the tongue.
b. Geniohyoid and mylohyoid muscles - support the body of the tongue.
B. Tongue – composed of skeletal muscle to manipulate food, helps form words, and serves as a sensory
organ for gustation. Anchored in the oral cavity by the lingual frenulum
a. The superior surface of the tongue is covered in epithelial projections called lingual
papillae. The human tongue possesses four primary types of lingual papillae with three of
the four containing taste buds:
i. Circumvallate papillae - 7 to 12 relatively large, round papillae shaped like the tip
of a pencil eraser surrounded by deep epithelial folds. These are found on the
posterior margin of the tongue in a V pattern. Each circumvallate papilla possesses
about 100 taste buds along the sides of each papilla.
ii. Fungiform papillae - mushroom-shaped papillae within shallow depressions
scattered over the anterior 2/3 surface of the tongue. These typically possess only 5
taste buds located on the tops of each papilla.
iii. Filiform papillae - hair-like papillae scattered all over the anterior 2/3 of the tongue.
They do not have taste buds associated with them. These are designed to create
friction on the surface of the tongue.
iv. Foliate papillae - 4-5 vertical folds located on the lateral margins of the posterior
region of the tongue. Each foliate papilla possesses many taste buds.
b. Many of the papillae contain test receptors and specialized epithelial cells in sensory
structures called taste buds. Although we have more than 10,000 taste buds when we are
 young, an adult possesses only about 5000 taste buds and by age 50, less than 1/3 of the
taste buds still exist.
C. Salivary glands - exocrine glands that produce and secrete saliva via ducts connected to the oral cavity.
Saliva is a mixture of water, mucins, buffers, lysozymes, and enzymes.
1. Functions of the salivary glands:
a. Moistens and lubricates the mouth and food;
b. Cleanses food by defensins, lysozymes, and IgA antibodies;
c. Dissolves food chemicals for gustation;
d. Initiates chemical digestion of complex carbohydrates by salivary amylase and fats by
lingual lipase.
2. Three types of salivary glands:
a. Parotid glands - contains only serous cells for the production of salivary amylase,
lysozymes, and IgA antibodies. Secrete into the parotid duct to the oral cavity.
b. Sublingual glands - contains mostly mucous cells and produces a watery mucin to act as a
buffer and lubricant. Secrete into the sublingual ducts.
c. Submandibular glands - equal numbers of serous cells and mucous cells and therefore
secrete a mixture of mucin and salivary amylase. Secrete into the submandibular ducts.
d. The parotid glands are innervated by CN VII (facial nerve) while the sublingual and
submandibular glands are innervated by CN IX (glossopharyngeal nerve).
D. Teeth – breaks food into smaller pieces (mastication) thereby increasing the surface area for chemical
digestion
1. Types of teeth
a. Primary dentition or deciduous teeth (sometimes called milk teeth or baby teeth) 20 teeth
erupt through the gums during embryonic development.
b. Secondary dentition or permanent teeth fully replace the baby teeth by age 21. There are
32 permanent teeth in four general types:
i. Incisors - blade-shaped teeth at the front of the mouth; for cutting and nipping;
possess a single root; 8 total (4 on top/4 on bottom) described as either central or
lateral incisors.
ii. Canines - conical-shaped with a sharp ridgeline and pointed tip; for tearing and
piercing; possess a single root; sometimes called cuspids or eyeteeth; 4 total (2 on
top/2 on bottom)
iii. Premolars - flattened crowns with prominent ridges; for grinding, mashing and
crushing; possess one or two roots; sometimes called bicuspids; 8 total (4 on top/4
on bottom) described as either 1st or 2nd premolars.
iv. Molars - flattened crowns with prominent ridges; for grinding and crushing;
typically possess three or more roots; 12 total (6 on top/6 on bottom) described either
as 1st, 2nd, or 3rd molars. The 3rd molars are sometimes called wisdom teeth.
2. Anatomy of a Tooth
a. Crown - exposed part of the tooth that projects into the oral cavity. Covered by enamel
over a highly mineralized (bone-like) material called dentin and a soft pulp located within
the pulp cavity.
b. Neck - narrow area that serves as the boundary between the crown and the root
c. Root - below the gingiva (or gums) and sits into the sockets of the jawbone, called the
alveoli, to form numerous gomphosis joints. Covered by cementum and anchored by the
periodontal ligament. Holds the pulp cavity filled with pulp and extends down into the
root canal and apical foramen.
E. Pharynx – more commonly called the throat possesses skeletal muscle tissue for swallowing. The pharynx
is divided into three regions:
1. Nasopharynx - the superior portion of the pharynx located between the soft palate and the internal
nares. Lined with pseudostratified columnar epithelium and houses the pharyngeal tonsils.
Transports AIR only. Food does not normally pass here.
 2. Oropharynx - extends between the soft palate and the level of the hyoid bone. At the boundary
between the nasopharynx and the oropharynx, the epithelial tissue changes from pseudostratified
columnar to stratified squamous epithelium; accommodates the movement of food through this
region and protects against abrasion.
3. Laryngopharynx - includes the portion of the pharynx between the hyoid bone and the entrance to
the larynx and esophagus. Like the oropharynx, the laryngopharynx is lined with stratified
squamous epithelium.
F. Esophagus – a hollow muscular tube that functions to carry bolus from the pharynx to the stomach; passes
through an opening in the diaphragm called the esophageal hiatus. Basic structure of the esophagus:
1. Upper third of the esophagus is composed of skeletal muscle for swallowing, the middle third is a
mixture of skeletal and smooth muscle, and the lower two-third is made entirely of smooth muscle
and undergoes peristalsis.
2. Upper portion is lined with stratified squamous epithelium while the lower portion near the
stomach is lined with simple columnar epithelium.
3. Possesses many esophageal glands that produce mucus to lubricate the bolus as it moves to the
stomach.
4. The upper esophageal sphincter prevents backflow of food into the oral cavity while the cardiac
sphincter, also known as the gastroesophageal sphincter or the lower esophageal sphincter,
prevents backflow of stomach contents into the esophagus.
G. Deglutition (aka swallowing) - The movement of food from the oral cavity into the pharynx and then into
the esophagus. Deglutition is divided into three phases:
1. buccal phase which is voluntary
2. pharyngeal phase which is involuntary controlled by the autonomic nervous system
3. esophageal phase which is involuntary.

23.4The Stomach (Beginning of the Lower Gastrointestinal Tract)

A. The organs of the lower GI are located within the peritoneal cavity and are lined by a serous membrane
called the peritoneum and divided into a visceral peritoneum and parietal peritoneum.
B. Stomach – a muscular, expandable, J-shaped organ that converts the bolus into chyme.
1. Regions of the stomach – divided into four distinct regions:
a. Cardiac region – also known as the cardia; area where the esophagus empties into the
stomach; the cardiac sphincter serves as the junction between the esophagus and stomach
and prevents backflow of stomach contents into the esophagus.
b. Fundus – the dome-shaped portion at the top of the stomach and lies superior to the junction
between the stomach and esophagus.
c. Body – the largest region of the stomach; area between the fundus and the curve in the J;
functions as a mixing bowl for ingested food and secretions from the walls.
d. Pyloric region – forms the sharp curve of the J. As mixing movements occur during
digestion, the pylorus frequently changes shape; terminates in a pyloric sphincter which
regulates the flow of chyme out of the stomach and into the duodenum.
2. Gross anatomy of the stomach:
a. Greater curvature – the lateral surface of the stomach to which the greater omentum is
attached. The greater omentum forms an enormous pouch that drapes down over the
anterior surface of the small intestine. Adipose tissue in the greater omentum conforms to
the shape of the surrounding organs, providing padding and protection across the abdomen.
b. Lesser curvature – the medial surface of the stomach to which the lesser omentum is
attached; stabilizes the position of the stomach and provides an access route for blood
vessels to enter or leave the liver.
c. Rugae – longitudinal folds within the lumen of the stomach which aid in the stretch and
expandability of the stomach. As the stomach fills, the rugae gradually flatten until they
almost disappear.
1. Microscopic anatomy of the stomach:
 a. The mucosa of the stomach is simple columnar epithelium. The muscularis externa of the
stomach is composed of a third, inner layer of smooth muscle oriented diagonal to the axis
of the stomach (oblique layer). This extra layer provides the stomach with the ability to
churn food for mixing with enzymes.
b. Gastric pits – shallow depressions within the inner surface of the stomach. Each gastric pit
communicates with several gastric glands that extend deep into the lamina propria.
c. Gastric glands – located in the fundus and body; secrete most of the stomach juices used
for gastric digestion. The gastric glands are dominated by several types of cells:
i. Chief cells - secretes the inactive enzyme pepsinogen, which when activated to form
pepsin, can begin the process of protein digestion. In newborn infants (but not
adults), the chief cells also secrete gastric lipase and rennin which are essential in
the digestion of milk.
ii. Parietal cells - secrete hydrochloric acid for activating the pepsinogen and
intrinsic factor which is important in the absorption of vitamin B12.
iii. G cells - enteroendocrine cells that produce a variety of hormones important in the
digestive processes:
a) Gastrin – increases stomach motility and churning and stimulates the release
of HCl from parietal cells.
b) Somatostatin – inhibits stomach motility and emptying.
c) Ghrelin – regulates food intake stimulating hunger and satiety.
35.5 The Small and Large Intestines (Part of the Lower Gastrointestinal Tract)
A. Small Intestine – specialized for the maximum absorption of nutrients. Receives chyme from the stomach
and serves as the site for the majority of digestion and absorption of nutrients.
1. The small intestine performs peristalsis AND segmentation.
2. Gross anatomy of the small intestines:
a. Duodenum = upper region of the small intestine (about 10 – 12 inches in length); receives
chyme from the stomach as well as digestive enzymes from the pancreas and bile from liver
and gallbladder via the sphincter of Oddi. Contains large number of duodenal glands -
called Brunner’s glands to secrete mucous.
b. Jejunum and Ileum = middle portion (about 8 feet in length) and lower portion (about 12
feet in length) where continued chemical digestion and absorption occurs. The lower
portion of the ileum contains Peyer’s patches and drains into the large intestine at the
ileocecal valve.
c. Plicae circularis - deep, permanent folds of the mucosa and submucosa; oriented transverse
to the axis; and increase the surface area of the intestine; most are located within the
jejunum.
d. Mesenteries - connective tissue extensions of the serosa that help to anchor the small
intestines and holds the approximately 20 ft of intestines into a tight mass. Called
mesentery proper when attached specifically to the small intestine.
3. Microscopy Anatomy
a. The mucosa is composed of simple columnar epithelium to maximize absorption and
secretion.
b. Intestinal villi - finger-like projections that sit over the surface of the plicae circularis and
continue to greatly increase surface area. Each villus contains an artery, vein, and
specialized lymph capillaries called lacteals for the absorption of chyle.
c. Microvilli - tiny projections of the plasma membrane of each simple columnar cell creating
a fuzzy appearance called brush border cells.
d. Peyer’s Patches - aggregated masses of lymphoid tissue with large numbers of lymphocytes
cells.
2. Secretions produced by the enteroendocrine cells of the small intestine:
 a. Secretin – released when acidic chyme enters the small intestine; causes an increase in the
secretion of bicarbonate-rich juices from the pancreas to buffer the acidity and bile from the
liver/gallbladder to emulsify fats.
b. Cholecystokinin (CCK) – released when fatty or protein rich chyme enters the small
intestine; causes release of enzyme-rich juices from the pancreas and bile from the liver and
gallbladder.
c. Gastric Inhibitory Peptide (GIP) – released when fats and carbohydrates enter the small
intestine; slows gastric activity and stimulates the secretion of insulin to affect metabolism
d. Vasoactive Intestinal Peptide (VIP) – stimulates the secretion of intestinal glands, dilates
regional capillaries to enhance absorption, and inhibits acid production in the stomach.
3. Brush border enzymes = complete the digestion of organic molecules
a. Aminopeptidase, dipeptidase, and carboxypeptidase – process short peptides into
individual amino acids.
b. Nucleosidases and phosphatases break down nucleic acids to produce a nitrogen base,
phosphate group, and five-carbon sugar.
c. Dextrinase, maltase, sucrase, and lactase all break down disaccharides and
oligosaccharides into monosaccharides.
B. Large Intestine – stores and concentrates fecal material; also known as the large bowel; averages about 5
feet in length.
2. The large intestine has three major functions:
a. Reabsorption of water and compaction of the intestinal contents into feces.
b. Absorption of important vitamins produced by bacterial action on indigestible materials.
Particularly vitamin B5, Biotin and vitamin K.
c. Storage of fecal material prior to defecation.
3. Gross Anatomy
a. Teniae coli - bands of longitudinal smooth muscle that creates pocket-like sacs called
haustra. Haustra allow for the expansion and elongation of the colon.
b. The large intestine is divided into three main segments:
i. Cecum = material arriving from the ileum through the ileocecal valve first enters
into an expanded sac-like region called the cecum. The cecum collects and stores
materials from the ileum and begins the process of compaction.
ii. Colon = possesses a thinner wall and larger diameter than the small intestine.
Subdivided into four regions: ascending colon (patient’s right), transverse colon
(from patient’s right to left), descending colon (patient’s left) and sigmoid colon (s-
shaped region)
iii. Rectum = the last 15 cm of the digestive tract and serves as an expandable organ for
temporary storage of feces. Possesses rectal valves to separate the feces from
flatulence. The distal portion of the rectum, the anal canal, is composed of two
muscles that work together to regulate defecation. The internal anal sphincter
muscle, made of smooth muscle, stimulates the urge. The external anal sphincter
muscle, made of skeletal muscle, allows the person to control bowel movements.
The anus is the exit of the anal canal.
c. Appendix - wormlike structure extending from the cecum that contains masses of lymphoid
tissue and plays a role in body immunity.
d. Mesenteries - connective tissue extensions of the serosa that help to anchor the large
intestine to the body wall. Called mesocolon when attached to the large intestine.
4. Microscopic Anatomy
a. Simple columnar epithelium for absorption of water and electrolytes except in the rectum
and anal canal where it is predominantly stratified squamous epithelium for protection
against abrasion.
b. No villi, no plicae circularis, no enzyme-secreting cells.
c. Large numbers of goblet cells to produce mucus that lubricates feces.
 d. Bacterial flora synthesizes vitamin B5, Biotin, and most of the vitamin K that the liver
requires to make blood clotting proteins. Bacteria produce several compounds that
contribute to the odor of feces, including ammonia, indole and skatole, and hydrogen
sulfide.
5. Only 200 mL of feces is ejected in a typical bowel movement. Fecal material is 75% water, 5%
bacteria, and the remaining 20% is a mixture of indigestible materials, inorganic material, and
epithelial cells.

23.6 Accessory Organs of the Digestive Tract

B. Liver and Gallbladder – The liver is the largest internal organ in the body and is responsible for the
production of bile, an important emulsifier.
1. The liver is primarily a metabolic organ but has only one digestive function:
a. Filters and processes nutrient-rich blood of carbohydrates, proteins, and lipids from the
intestine.
b. Cholesterol metabolism and regulation of blood cholesterol levels.
c. Removes drugs and hormones from circulation.
d. Produces bile which emulsifies fats in the small intestine.
2. Gross Anatomy
a. Consists of a right lobe and left lobe separated by the falciform ligament.
b. The caudate lobe (next to the inferior vena cava) and the quadrate lobe (next to the
gallbladder) are visible on the inferior surface.
c. Bile exits from the right and left lobes of the liver via the right and left hepatic ducts. The
right and left hepatic ducts merge to form the common hepatic duct. The common hepatic
duct merges with the cystic duct from the gallbladder to form the common bile duct. The
common bile duct drains into the duodenum via the sphincter of oddi, or hepatopancreatic
sphincter.
3. Microscopy Anatomy
a. Liver lobules form the structural and functional units of the liver.
b. Each lobule consists of liver cells known as hepatocytes. Hepatocytes produce bile and
process nutrients.
c. Within the portal triad located on the corners of the liver lobules are three vessels: a hepatic
portal vein and hepatic artery and a bile duct. The hepatic portal vein and hepatic artery
bring nutrient-rich blood into the liver where it filters through the hepatocytes lining the
liver sinusoidal capillaries that drain towards the central vein in the middle of each lobule.
d. Kupffer cells remove debris (bacteria and dead blood cells).
e. Filtered blood enters the central vein which then drains into the hepatic vein that exits the
liver and empties into the inferior vena cava.
f. Meanwhile, bile produced by the hepatocytes travels opposite through the bile canaliculi
toward the portal triad draining into the bile ducts which merge to form either the right or
left hepatic ducts; exit the liver and moves the bile to the gallbladder for storage.
C. Pancreas – the pancreas secretes pancreatic juice containing buffers and enzymes formed by the exocrine
cells called acinar cells (or acini). The pancreatic juice drains via the pancreatic duct towards the small
intestine. Empties into the duodenum through the sphincter of oddi along with bile from the liver and
gallbladder.
1. Composition of pancreatic juice produced by acini:
a. Sodium bicarbonate – serves as a buffer of the HCl produced in the stomach.
b. Pancreatic proteases – secreted as inactive enzymes but become activated in the small
intestine to form the activated: carboxypeptidase, chymotrypsin, and trypsin. These
enzymes break down large polypeptides into oligopeptides, tripeptides, dipeptides and some
amino acids.
 c. Pancreatic amylase (almost identical to salivary amylase) – further digests carbohydrates
only briefly started in the mouth into oligosaccharides and disaccharides.
d. Pancreatic lipases – breaks down lipids into fatty acids and glycerol.
e. Pancreatic nucleases - breaks down nucleic acids such as DNA and RNA.
2. Islets of Langerhans release insulin and glucagon that are important in carbohydrate metabolism
(discussed in next chapter). These are endocrine cells!
D. The gallbladder stores and concentrates bile until needed by the small intestine.
1. The gallbladder is divided into three regions: the fundus, body, and neck.
2. The release of CCK by the duodenum triggers dilation of the sphincter of oddi and contraction of
the gallbladder.
3. Bile leaves the gallbladder via the cystic duct, combines with the common hepatic duct from the
liver to form the common bile duct. The common bile duct drains into the duodenum via the
sphincter of oddi, or hepatopancreatic sphincter.

23.7 Chemical Digestion and Absorption: A Closer Look

A. Chemical digestion - the chemical and enzymatic breakdown of foods into small organic molecules that
can be absorbed such as carbohydrates, proteins and lipids.
B. Absorption - movement of small organic end products and other important molecules (such as water,
electrolytes, carbohydrates, proteins, lipids, nucleic acids, vitamins, and minerals like Fe or Ca) from the
lumen of the GI tract into the interstitial fluids, blood, or lymph.
C. Disorders of the Digestive System
1. Dental caries – erosion in the enamel leading to cavities; tooth decay generally results from the
action of bacteria that normally inhabit the mouth. Dental plaques are the first sign of bacteria.
2. Gingivitis – inflammation of the gums usually caused by bacterial infection which can cause
erosion of the gums, and if not treated leads to periodontal disease where the root becomes damaged
and eventual tooth loss occurs.
3. Halitosis – bad breath; usually caused by bacteria
4. Mumps – swollen parotid glands as a result of a virus (myxovirus) infection.
5. Hiatal hernia – occurs when a portion of the stomach (or sometimes a loop of the small intestine)
gets caught in the esophageal hiatus.
6. Hemorrhoids – varicose veins of the rectum and anus.
7. Acid reflux – failure of the cardiac sphincter to prevent the backflow of stomach acids into the
esophagus; also called heart burn. As a chronic condition, it is called GERD – gastroesophageal
reflux disease.
8. Peptic and duodenal ulcers – deterioration in the wall of the stomach or duodenum caused by
Helicobacter pylori infection.
9. Ascites – accumulation of peritoneal fluid (due to liver disease, kidney disease, and heart failure)
causes characteristic abdominal swelling.
10. Pancreatitis – inflammation of the pancreas from either drugs, toxins, bacterial or viral infections,
or blockages. If not treated can be fatal (1/8th of all cases).
11. Hepatitis – inflammation of the liver as a result of alcohol consumption, viral infection (hepatitis A,
B, and C are most common), or drugs.
12. Cirrhosis – chronic inflammation of the liver leading to scarring of the liver.
13. Gallstones – highly concentrated cholesterol derivatives in bile. If the gallstones are so large that
they block the bile ducts and damage the wall of the gallbladder it is called cholecystitis.
14. Jaundice – accumulation of bilirubin (yellow) in the skin as a result of a blockage or liver disease
15. Enteritis – inflammation of the small intestine
16. Colitis – inflammation of the colon, often involving diarrhea or constipation.
17. Diarrhea – watery stool caused by rapid movement of food through the digestive tract
18. Constipation – hard and difficult to pass stool; typically due to slow movement through the
digestive tract or not enough fiber
19. Diverticulitis – inflamed herniation in the wall of the large intestines.
 20. Appendicitis – inflammation of the appendix as a result of a blockage trapping infectious bacteria
within the lumen
CHAPTER TWENTY-FIVE
The Urinary System
Introduction
A. Urology=the branch of medicine that deals with urinary system and male reproductive tract.
B. Functions of the excretory system
1. Adjusts blood volume and blood pressure.
2. Regulates plasma concentrations of sodium, potassium, chloride and other ions.
3. Stabilizes blood pH.
4. Excretes metabolic wastes and drugs or toxins.
5. Regulates RBC production, synthesizes calcitriol (a.k.a. vitamin D), and performs gluconeogenesis.
C. Basic Gross Anatomy
1. Two bean shaped kidneys that are metabolically very active. At rest they receive about 25% of the
cardiac output. The kidneys perform the excretory functions of the urinary system and produce
urine, a fluid containing water, ions, and small soluble compounds.
2. Two ureters that receive urine from the kidneys and conduct it to the urinary bladder. Urine
movement involves a combination of gravity and peristalsis.
3. The urinary bladder receives and stores urine prior to elimination from the body. The urinary
bladder possesses rugae and is lined with transitional epithelium to allows the urinary bladder to
stretch.
4. Urethra drains urine from urinary bladder and transports the urine to the outside. In females, it
only drains urine. In males, it drains urine and semen. At the base of the bladder there is an
internal and external urethral sphincter that regulates urination.

25.1 Physical Characteristics of Urine

A. Characteristics of Normal Urine
1. Volume = a healthy adult typically produces 1200 mL of urine per day with an osmotic
concentration of roughly 1000 mOsm/L. Urine volumes can vary however between 700 – 2000 mL
per day.
2. Water content = 93% to 97% water.
3. Color = clear yellow because of an abundance of a yellow pigment called urochrome. If the urine
is not clear, it is described as turbid and may be suggestive of a bacterial infection. Urine should
contain no bacteria (sterile).
4. Odor = slightly aromatic when fresh but tends to develop an ammonia odor due to bacterial
metabolism. Can vary according to composition and diet.
5. pH = urine is slightly acidic ranging normally between 4.5 – 8.0 (but averaging about pH 6)
6. Specific gravity = textbook 1.003 – 1.030)
7. Normal Laboratory Values for Solutes in Urine:
Sodium (Na+) = 40 – 220 mEq/L Proteins = 0.000 mg/dL
+
Potassium (K ) = 25 – 100 mEq/L Urea = 1800 mg/dL
-
Bicarbonate (HCO3 ) = 1.9 mEq/L Creatinine = 150 mg/dL
Glucose = 0.009 mg/dL Uric acid = 40 mg/dL
Lipids = 0.002 mg/dL Ammonia = 60 mg/dL
 8. Abnormal Constituents of Urine:
Substance Name of Condition Possible Cause
Glucose Glycosuria Diabetes mellitus
Proteins Proteinuria or albuminuria Pregnancy; heart failure, renal disease
Ketone bodies Ketonuria Starvation or untreated diabetes
Hemoglobin Hemoglobinuria Severe burns; hemolytic anemia
Bile pigments Bilirubinuria Liver disease; obstruction of bile ducts
Erythrocytes Hematuria Trauma; kidney stones; infection
Leukocytes Pyuria Urinary tract infections

25.2 Gross Anatomy of Urine Transport

A. Filtrate modification and urine production ends when the fluid enters the renal pelvis. The urinary
tract (the ureters, urinary bladder, and urethra) is responsible for the transport, storage, and
elimination of urine.
1. A pyelogram is an image of the urinary system obtained by taking an x-ray of the kidneys after a
radiopaque compound has been administered intravenously. Such an image provides an
orientation to the relative sizes and positions of the system’s main structures.
2. The ureters are a pair of muscular tubes that extend from the kidneys to the urinary bladder – a
distance of about 12 inches.
a. The ureters are retroperitoneal and are firmly attached to the posterior abdominal wall.
The paths taken by the ureters in men and women are different, due to variation in the
nature, size, and position of the reproductive organs.
b. The wall of each ureter consists of three layers: 1) an inner mucosa composed of
transitional epithelium and a surrounding lamina propria; 2) a middle muscular layer made
of longitudinal and circular bands of smooth muscle; and 3) an outer connective tissue
layer that is continuous with the renal capsule and peritoneum.
c. About every 30 seconds, peristaltic contractions begin at the renal pelvis and sweeps along
the ureter, forcing urine toward the urinary bladder.
3. The urinary bladder is a hollow muscular organ that functions as a temporary reservoir for the
storage of urine. A full urinary bladder can hold as much as 1 L of urine.
a. The urinary bladder is supported by three ligaments: 2 lateral umbilical ligaments that
pass along the sides of the bladder to the umbilicus (navel) and a single middle umbilical
ligament which extends from the anterior, superior border toward the umbilicus.
b. The walls of the urinary bladder contain a mucosa, submucosa, and muscularis layers. The
mucosa is composed of transitional epithelium and a lamina propria. The muscularis layer
consists of muscle in an inner and outer longitudinal layer with a circular layer in between.
Collectively, these three layers of smooth muscle form the powerful detrusor muscle that
compresses the urinary bladder and expels its contents into the urethra.
c. The urinary bladder possesses numerous longitudinal folds in its internal surface called
rugae. As the bladder fills, the rugae disappear to allow the organ to stretch.
d. The ureters penetrate the posterior wall of the urinary bladder without entering the
peritoneal cavity. They pass through the bladder wall at an oblique angle creating two slit-
like holes called the ureteral orifices. This shape helps prevent the backflow of urine
toward the ureter and kidneys when the urinary bladder contracts.
 e. In the bottom of the bladder is a single internal urethral orifice. It contains a muscular
internal urethral sphincter composed of smooth muscle. This sphincter provides an
involuntary control over the discharge of urine from the bladder.
f. The trigone is the triangular area bound by the ureteral orifices and the single urethral
orifice.
4. The urethra extends from the neck of the urinary bladder to the urethral orifice. The urethra
transports urine to the exterior of the body.
a. The urethra of a male and female differs in length and in function. The male urethra
transports urine and semen while the female urethra transports only urine. In males, the
urethra must extend the length of the penis and is about 8 inches long. In females the
urethra is approximately in 1.5 to 2 inches in length.
b. In both sexes, where the urethra passes through the urogenital diaphragm, a circular band
of skeletal muscle forms the external urethral sphincter. This muscular band acts as a
valve to voluntarily control urination.
c. The urethral lining consists of epithelial tissues that vary from transitional at the neck of
the urinary bladder to stratified columnar at the midpoint, to stratified squamous near the
external urethral orifice. The lamina propria is thick and elastic, and the mucous
membrane is thrown into longitudinal folds. Mucin-secreting cells are located in the
epithelial pockets. Connective tissue of the lamina propria anchors the urethra to the
surrounding tissues.
B. Urination involves a reflex coordinated by the nervous system.
1. Urine reaches the urinary bladder by peristaltic contractions of the ureters. The process of
urination, also called micturition, is coordinated by the micturition reflex.
a. Stretch of the urinary bladder as a result of urine accumulation stimulates stretch receptors
in the wall. Afferent fibers in the pelvic splanchnic nerves carry the information to the
sacral spinal cord generating a local reflex and a central reflex.
b. Local reflex – parasympathetic pre-ganglionic motor fibers in the pelvic nerves carry motor
commands back to the urinary bladder. Post-ganglionic intramural ganglia stimulate the
contraction of the detrusor muscle which elevates the hydrostatic pressure within the
urinary bladder.
c. Central reflex – an interneuron relays the sensation to the thalamus where projection
fibers relay information from the thalamus to the cerebral cortex for conscious perception
of the urge to urinate. If convenient at the time, the individual then voluntarily relaxes the
external urethral sphincter. Voluntary relaxation of the external urethral sphincter causes
relaxation of the internal urethral sphincter. Because the local reflex has already elevated
pressures within the urinary bladder, relaxation of the external and internal urethral
sphincters leads to urination.
2. A healthy adult typically produces approximately 1200 mL of urine per day.
25.3 Gross Anatomy of the Kidney
A. External (macroscopic) anatomy
1. The kidneys are located retroperitoneally on each side of the vertebral column between the 12th
thoracic vertebrae (T12) and the third lumbar vertebra (L3).
2. Right kidney is lower than the left one because liver size and position.
3. Renal hilus = a prominent medial indention where blood vessels, nerves, lymphatic vessels enter
and exit the kidney.
4. Connective tissue layers:
a. Renal capsule – a fibrous joint capsule similar to a “candy shell coating” composed of
dense irregular connective tissue that covers the outer surface of the kidney. The renal
capsule also lines the renal sinus, an internal cavity within the kidney.
 b. Renal Fat Pad – also known as the perinephric fat capsule. A thick middle layer of fatty
tissue that insulates and cushions the kidneys.
c. Renal fascia – is the outermost, dense connective tissue that anchors the kidney and
adrenal glands.
B. Internal (microscopic) anatomy
1. Renal cortex = outer most portion of the kidney and is in contact with the renal capsule. The renal
cortex is light red in color and has a granular appearance.
2. Renal medulla = extends from the renal cortex to the renal sinus. The renal medulla possesses
many conical-shaped masses called renal pyramids each ending in a nipple-like structure called a
renal papillae.
3. Renal columns = inward extensions of cortical tissue that separates the pyramids.
4. Renal pelvis = a flat funnel shaped tube that drains urine from the cortex and medulla toward the
ureters.
5. Minor calyx = branch of the renal pelvis that encloses the top of a single renal pyramid.
6. Major calyx = forms from the fusion of 4-5 minor calyces.
7. Nephrons = the functional units of the kidney.

C. Blood Supply to the kidneys.

1. Renal arteries – enter the kidney at the renal hilus to bring oxygenated, unfiltered blood into the
kidney.
2. The renal arteries branch into smaller and smaller vessels in the following order:
i. Segmental arteries
ii. Interlobar arteries
iii. Arcuate arteries
iv. Cortical radiate arteries
v. Afferent arterioles
vi. Glomerulus (the first capillary bed)
vii. Efferent arterioles
viii. Peritubular capillaries or vasa recta capillaries (the second capillary bed)
3. The second capillary beds (whether they be peritubular capillaries or vasa recta) will transport
clean, deoxygenated blood to the veins and out of the kidneys in the following sequence:
i. Cortical radiate veins
ii. Arcuate veins
iii. Interlobar veins
iv. Renal veins (NOTE: there is no segmental veins)
v. Inferior vena cava

25.4 Microscopic Anatomy of the Kidney

A. NEPHRONS = the functional units of the kidney. Each kidney contains approximately 1.25 million
nephrons with a combined length of 85 miles. There are two types of nephrons:
1. Cortical nephrons (85%) are located almost entirely in the cortex and are responsible for most of
the regulatory functions of the kidneys. Wrapped by a peritubular capillary bed which reabsorbs
nutrients that were inadvertently filtered as a component of the filtrate. The peritubular
capillaries tend to primarily surround the PCT and DCT.
2. Juxtamedullary nephrons (15%) which have long loops of Henle that deeply invade the medulla.
These are associated with vasa recta and the production of concentrated urine as they tend to be
long straight capillaries that surround the loops of Henle rather than the PCT and DCT.
B. RENAL CORPUSCLE = responsible for filtration
 1. Glomerulus = first capillary bed composed of fenestrated capillaries which are exceptionally
porous allowing large amounts of solutes to pass from blood and into the surrounding Bowman’s
capsule. The substance removed from blood is called filtrate.
2. Bowman’s capsule = collection tubule that surrounds the glomerulus and is primarily simple
squamous epithelium, a basement membrane.
a. Podocytes = large cells located in the visceral layer of the Bowman’s capsule which possess
complex foot processes called pedicles. These wrap densely around the glomerulus
creating filtration slits that limit the movement of large materials out of the blood and into
the Bowman’s capsule.
b. Juxtaglomerular cells = smooth muscle cells that act as mechanoreceptors that sense
blood pressure in the afferent arteriole. JG cells secrete renin in response to low blood
pressure. Recall that renin in turn activates angiotensin I into angiotensin II which is a
potent vasoconstrictor.
c. Macula densa cells = osmoreceptors that respond to solute concentrations in the filtrate
and filtrate flow. Low osmolality (slow flow) stimulates vasodilation. High osmolality (fast
flow) stimulates vasoconstriction. The macula densa also monitor oxygen changes and if a
drop in blood oxygen is detected, these cells will secrete EPO to stimulate an increase in
red blood cell production and the oxygen carrying capacity of the blood.
d. Mesangial cells = located between the network of vessels forming the glomerulus. The
mesangial cells are phagocytic cells with contractile abilities. These cells contract or relax
to control capillary diameter and hence the rate of blood flow and glomerular filtration
rates.
C. RENAL TUBULES = responsible for absorption and secretion processes. Once the filtrate enters the renal
tubules, it is now called tubular fluid.
1. Proximal convoluted tubules with walls of brush-border simple cuboidal epithelium for absorption
and secretion are located in the renal cortex. The PCT absorbs 99% of glucose, amino acids, and
other organic compounds. The PCT also absorbs sodium, potassium, bicarbonate, magnesium,
phosphate, and sulfate ions.
2. Loop of Henle with ascending and descending ends and a thick segment of simple cuboidal and a
thin segment of simple squamous are located in the medulla. Primarily responsible for the
establishment of an osmotic gradient in the renal medulla; this gradient promotes water
reabsorption from the tubular fluid in the nephron and collecting system.
3. Distal convoluted tubules with walls of non-ciliated simple cuboidal epithelium forms the last
segment of the nephron and makes continued adjustments in the solute composition of the
tubular fluids through a combination of secretion and reabsorption mechanisms.
4. Collecting ducts carry tubular fluids through the osmotic gradient in the renal medulla and make
final adjustments in the volume and osmotic concentrations in the urine.

25.5 Physiology of Urine Formation

A. The production of urine involves three main processes:
1. Glomerular Non-selective filtration occurs at the glomerulus and Bowman’s capsule.
2. Tubular reabsorption occurs in the proximal convoluted tubule (PCT), the loop of Henle, and the
first part of the distal convoluted tubule (DCT).
3. Tubular secretion occurs mostly in the PCT for most materials but in the DCT for K+.
B. Non-Selective Filtration
1. Unfiltered blood in the afferent arterioles enters the glomerulus.
2. Pretty much anything small enough (except for blood cells and plasma proteins) is forced into the
Bowman’s capsule as the filtrate.
 3. Efferent arterioles transport filtered blood away from the glomerulus towards the second capillary
bed, either the peritubular capillary bed or vasa recta.
4. NOTE: the glomerulus is a unique capillary bed because arterioles move blood into the capillary
bed and transport blood away from the capillary bed! Almost all other capillary beds in the body
have venules taking blood away from the capillary bed!!!
5. Glomerular Filtration Rate (GFR) is the amount of filtrate formed in both kidneys per minute. In a
healthy individual, the kidneys filter 1200 mL of blood through the nephron per minute. As a
result of GFR, approximately 125 mL of filtrate are produced per minute. The majority of this (124
mL) is reabsorbed in the renal tubule portion of the nephron. Therefore, only about 1 mL of urine
is produce for each 125 mL of glomerular filtrate.
a. Glomerular Hydrostatic Pressure (GHP) – generates a push out of the glomerulus and into
the Bowman’s capsule so that water and solutes are forced out of the plasma and into the
filtrate.
b. Blood Colloid Osmotic Pressure (BCOP) – generates a suction into the glomerulus so that
water and solutes are drawn out of the filtrate and into the plasma.
c. Capsular Hydrostatic Pressure (CsHP) – generates a push out of the Bowman’s capsule and
into the glomerulus so that water and solutes are forced out of the filtrate and into the
plasma.
d. Capsular Colloid Osmotic Pressure (CsOP) – generates a suction into the Bowman’s
capsule which draws water and solutes out of the glomerulus from the plasma and into the
filtrate.
e. Net Filtration Pressure (NFP) – the difference between the forces favoring filtration. NFP =
(GHP – BCOP) – (CsHP – CsOP). For instance, assume GHP = 55 mmHg, BCOP = 25 mmHg,
CsHP = 15 mmHg, and CsOP = 0 mmHg. Therefore NFP = (55 – 25) – (15 – 0) = 10
mmHg. Since NFP is a positive number it indicates a net movement of materials OUT of the
glomerulus and into the Bowman’s capsule. The net movement out is called filtration.
6. The hydrostatic pressure of the glomeruli (GHP) is much higher (55 mmHg) than that of other
capillary beds (15-18 mmHg). As a result, more filtrate is produced by the glomeruli of the kidneys
(180 L per day) compared to all other capillary beds of the body combined (3 L per
day). Remember, the body only has 4-6 L of blood total so most of the filtrate produced by
glomeruli is immediately reabsorbed in the renal tubules.

25.6 Tubular Reabsorption & Secretion

A. As the glomerular filtrate enters the PCT, the loop of Henle, and the first part of the DCT, water, ions and
other substances are reabsorbed into the blood via the second capillary bed called the peritubular
capillary bed.
B. Most substances (urea, fat-soluble vitamins, and some drugs) simply diffuse from the tubule lumen
directly into the peritubular capillary bed.
C. Ions may be reabsorbed through a combination of simple diffusion, facilitated diffusion, active transport,
or secondary active transport (review Chapter 3 if you do not recall these mechanisms).
D. Along the PCT, 108 L (out of the 180 L of filtrate produced per day) is reabsorbed from the tubular fluid.
E. Know the following percentages for PCT reabsorption:
1. 99% - 100% of filtered organic compounds (glucose, amino acids, and vitamins) are reabsorbed in
the PCT.
2. 80% of filtered bicarbonate (HCO3-) is reabsorbed in the PCT.
3. 60 - 70% of filtered H20 is reabsorbed in the PCT.
4. 65% of filtered Na+ is reabsorbed in the PCT.
5. 65% of filtered Cl- is reabsorbed in the PCT.
 F. Although most reabsorption occurs in the PCT, the filtrate now enters the loop of Henle where water
reabsorption continues on the descending portion and solute reabsorption (particularly Na+) occurs in the
ascending portion. Remember the statement: Water follows Na+ while K+ always moves opposite to Na+
movement (when Na+ is reabsorbed, water is reabsorbed and potassium is secreted).
G. Only about 15 – 20% of the initial filtrate volume reaches the DCT, and the concentrations of electrolytes
and organic wastes in the arriving tubular fluid no longer resembles the concentrations of blood plasma.
In the DCT, a combination of reabsorption and secretion further alters the solute composition of the
tubular fluid.
H. Furthermore, the volume and osmotic concentration of the tubular fluid can be further adjusted by the
collecting ducts:
1. The water permeability of the PCT and Loop of Henle cannot be adjusted, and water reabsorption
occurs whenever the osmotic concentration of the peritubular fluid exceeds that of the tubular
fluid. Because these water movements cannot be prevented, they are obligatory water
reabsorption. Obligatory reabsorption usually recovers 85% of the volume of filtrate produced.
2. The volume of water lost in urine depends on how much water in the remaining tubular fluid (15%
percent of the filtrate) is reabsorbed along the DCT and collecting ducts. The amount can be
precisely controlled by a process called facultative water reabsorption. Most facultative water
reabsorption is regulated by the hormone ADH which is produced by the hypothalamus and
secreted by the pituitary gland.
I. Tubular Secretion
1. Tubular secretion involves the movement of substances out of blood (specifically from the
peritubular capillary bed) and into the remaining tubular fluid.
2. Substances commonly secreted include potassium ions, hydrogen ions, ammonia ions, by-products
of drugs and penicillin, creatinine, and some hormones.
a. Secretion of potassium ions is closely tied to sodium movements. If large amounts of
sodium are absorbed in the thick segment of the loop of Henle, large amounts of
potassium are secreted into the tubular fluid.
b. When the pH of the body fluids decreases (more acidic), hydrogen ions are secreted in
exchange for sodium ions.
c. Molecules too large to be filtered in the glomerulus can be secreted into the tubular filtrate
by carrier proteins located in the walls of the DCT.
3. Some substances are secreted by active transport while others move by passive transport
mechanisms.
4. The collection ducts drain the tubular fluid, now called urine, through the renal papillae into the
minor calyces which merge to form the major calyces which merge further to form the renal
pelvis. The renal pelvis exits the kidney at the renal hilus is connected to the top of the ureter
which undergo peristalsis to transport urine to the bladder for storage.

25.7 Regulation of Renal Blood Flow

A. Sympathetic Nerves - The kidneys are innervated by the sympathetic neurons of the autonomic nervous
system via the celiac plexus and splanchnic nerves. Reduction of sympathetic stimulation results in
vasodilation and increased blood flow through the kidneys during resting conditions. When the frequency
of action potentials increases, the arteriolar smooth muscle constricts (vasoconstriction), resulting in
diminished glomerular flow, so less filtration occurs. 
Stress as well as hormones can increase
vasoconstriction.
B. Autoregulation: The kidneys are very effective at regulating the rate of blood flow over a wide range of
blood pressures. Despite the changes in blood pressure GFR changes very little due to the following:
 1. Arteriole myogenic mechanism: The myogenic mechanism regulating blood flow within the kidney
depends upon a characteristic shared by most smooth muscle cells of the body. When you stretch
a smooth muscle cell, it contracts; when you stop, it relaxes, restoring its resting length.
2. Tubuloglomerular feedback: The tubuloglomerular feedback mechanism involves the JGA and a
paracrine signaling mechanism utilizing ATP, adenosine, and nitric oxide (NO). This mechanism
stimulates either contraction or relaxation of afferent arteriolar smooth muscle cells

25.8 Endocrine Regulation of Kidney Function

A. Renin (produced by the JG cells of the renal corpuscle) and Angiotensin II = renin release is triggered by a
drop in blood pressure causing Angiotensin I to be converted to Angiotensin II (a potent vasoconstrictor)
in the lungs. Angiotensin II constricts the capillaries forming the glomerulus which results in less filtrate
production which in turn raises blood volume and therefore raises blood pressure.
B. Aldosterone promotes the reabsorption of sodium ions (Na+) within the renal tubules and excretion of
potassium ions (K+). For example: Low blood sodium concentration causes adrenal cortex to increase
secretion of aldosterone. The aldosterone causes more sodium to be reabsorbed into the bloodstream.
Excess blood sodium levels will inhibit aldosterone secretion and therefore sodium reabsorption is shut
down so that the sodium will be lost in urine.
C. Antidiuretic hormone (ADH) produced by the hypothalamus and secreted by the posterior pituitary gland
(neurohypophysis); plays a role in water reabsorption at the DCT and collection ducts. Increased ADH
secretion = increases water reabsorption which in turn means less urine is produced.
D. Endothyline produced by endothelial cells of the renal blood vessels, mesangial cells, and cells of the DCT
and is an extremely powerful vasoconstrictor. This does not typically increase blood pressure in healthy
individuals. Can also decrease GFR.
E. Atrial natriuretic peptide (ANP) is the hormone produced by the atria of the heart which inhibits the
secretion of aldosterone therefore promoting the excretion of Na+ and ultimately the reabsorption of K+.
Remember that “water follows sodium” so if sodium is excreted, more water will be lost via urine.
Therefore, ANP acts as a diuretic.

25.9 Regulation of Fluid Volume and Composition

A. Volume Sensing Mechanisms - The body cannot directly measure blood volume, but blood pressure can
be measured. Blood pressure often reflects blood volume and is measured by baroreceptors in the aorta
and carotid sinuses. When blood pressure increases, baroreceptors send more frequent action potentials
to the central nervous system, leading to widespread vasodilation, resulting in increased filtration and
GFR and water loss. If pressure decreases, fewer action potentials travel to the central nervous system,
resulting in more sympathetic stimulation- producing vasoconstriction, which will result in decreased
filtration and GFR, and decreased water loss. 

B. Diuretics and Fluid Volume: A diuretic is a compound that increases urine volume. Increased urine output
can be promoted by vasodilation, hormones such as ADH as well as prescription drugs.
C. Regulation of Extracellular Sodium: As previously mentioned Sodium has a very strong osmotic effect and
attracts water.
D. Regulation of Extracellular Potassium: As previously mentioned Potassium is always going to move
counter to Sodium so as more Na+ is absorbed more K+ is secreted and vice versa.
E. Regulation of Chloride (Cl-): Chloride mimics Sodium and is important in acid–base balance in the
extracellular space and has other functions, such as in the stomach, where it combines with hydrogen ions
in the stomach lumen to form hydrochloric acid, aiding digestion.
F. Regulation of Ca++ and Phosphate: The parathyroid glands monitor and respond to circulating levels of
Ca++ in the blood. When levels drop too low, PTH is released to stimulate the DCT to reabsorb Ca++ from
 the forming urine. When levels are adequate or high, less PTH is released and more Ca++ remains in the
forming urine to be lost. Phosphate levels move in the opposite direction.
G. Regulation of H+, Bicarbonate, and pH: The acid–base homeostasis of the body is a function of chemical
buffers and physiologic buffering provided by the lungs and kidneys. Buffers, especially proteins, HCO32 − ,
and ammonia have a very large capacity to absorb or release H+ as needed to resist a change in pH. Urine
pH typically varies in a normal range from 4.5 to 8.0.
H. Regulation of Nitrogen Wastes: Nitrogen wastes are produced by the breakdown of proteins during
normal metabolism. Proteins are broken down into amino acids, which in turn are deaminated by having
their nitrogen groups removed. Ammonia is extremely toxic and is converted to urea in the liver.
I. Elimination of Drugs and Hormones: Water-soluble drugs may be excreted in the urine and are
influenced by one or all of the following processes: glomerular filtration, tubular secretion, or tubular
reabsorption. Drugs that are structurally small can be filtered by the glomerulus with the filtrate. Large
drug molecules such as heparin or those that are bound to plasma proteins cannot be filtered and are not
readily eliminated. Some drugs can be eliminated by carrier proteins that enable secretion of the drug
into the tubule lumen. As is the case with other substances, drugs may be both filtered and reabsorbed
passively along a concentration gradient.

25.10 The Urinary System and Homeostasis

A. Vitamin D Synthesis:
In order for vitamin D to become active, it must undergo a hydroxylation reaction in
the kidney. Activated vitamin D is important for absorption of 
Ca++ in the digestive tract, its
reabsorption in the kidney, and the maintenance of normal serum concentrations of Ca++ and phosphate.
B. Erythropoiesis: stimulates the formation of red blood cells in the bone marrow. 

C. Blood Pressure Regulation: Due to osmosis, water follows where Na+ leads. Much of the water the
kidneys recover from the forming urine follows the 
reabsorption of Na+. ADH stimulation of aquaporin
channels allows for regulation of water recovery in the collecting ducts. 

D. Regulation of Osmolarity: Blood pressure and osmolarity are regulated in a similar fashion. Severe hypo-
osmolarity can cause problems like lysis (rupture) of blood cells or widespread edema, which is due to a
solute imbalance. Severe hypertonic conditions may arise with severe dehydration from lack of water
intake, severe vomiting, or uncontrolled diarrhea. When the kidney is unable to recover sufficient water
from the forming urine, the consequences may be severe (lethargy, confusion, muscle cramps, and finally,
death).
E. Recovery of Electrolytes: Sodium, calcium, and potassium must be closely regulated.
F. pH Regulation: Recall that enzymes lose their three-dimensional conformation and, therefore, their
function if the pH is too acidic or basic.
G. Homeostatic Imbalances of the Urinary System
1. Pyelonephritis = infection or inflammation of the kidney.
2. Anuria = severely low urinary output (0-50 mL/day) as a result of injury, transfusion reactions, low
blood pressure, etc.
3. Oliguria = low urine output (50-500 mL/day)
4. Polyuria = excess urinary output resulting from hormonal or metabolic problems such as those
associated with diabetes or glomerulonephritis.
5. Dysuria = painful or difficult urination can occur with cystitis or urethritis or with urinary
obstructions. In males, an enlarged prostate gland can compress the urethra and lead to dysuria.
6. Hypospadias = urethral orifice is located on the ventral surface of the penis.
7. Diabetes insipidus = production of large quantities of urine resulting in severe dehydration and
intense thirst. Occurs as a result of low ADH release.
8. Renal calculi = kidney stones.
9. Urethritis = inflammation of the urethra.
10. Cystitis = inflammation of the bladder.
11. Incontinence = inability to control urination voluntarily, may involve periodic leakage (called stress
incontinence) or inability to delay urination (urge incontinence) or a continual, slow trickle of urine
from a bladder that is always full (overflow incontinence).
12. Urinary retention = inability to expel urine even though renal function is normal. Common in
males with enlarged prostate glands.
13. Polycystic kidney = an inherited condition that results in urine-filled cysts (or a chloride-rich fluid)
forming within the kidney.
14. Renal infarct = area of dead, or necrotic, renal tissue.