CHAPTER 50: INTRODUCTION TO THE

KIDNEY AND THE URINARY TRACT

CHAPTER 51: DIURETIC AGENTS

• This is indicated for the treatment of edema

(movement of fluid into the interstitial spaces)
associated with:
o Congestive heart failure, acute
pulmonary edema, liver disease.
RENAL PROCESS: • Treatment of hypertension.
• Decrease fluid pressure in the eyes.
• Glomerular filtration – straining of fluid into the • Decrease potassium levels.
nephron.
• Tubular secretion – actively removing
components from the capillary system and
depositing them into the tubule.
• Tubular reabsorption – removing components
from the tubule to return to the capillary system
and circulation.
THIAZIDE AND THIAZIDE-LIKE DIURETICS: blocking the actions of aldosterone in the distal
tubule.
• Block the chloride pump which keeps the
• Used as adjuncts with thiazide or loop diuretics
chloride and the sodium in the tubule to be or with patients who are especially at risk if
excreted in the urine. hypokalemia develops.
• Indicated for the treatment of edema associated
• Monitor for hyperkalemia.
with CHF and with liver and renal disease, and
as adjuncts for the treatment of hypertension. EXAMPLES OF POTASSIUM-SPARING
• Monitor for hypokalemia. DIURETICS INCLUDE:

EXAMPLES OF ORAL THIAZIDE DIURETICS: • Amiloride

• Eplerenone (Inspra)
• Chlorothiazide (Diuril)
• Spironolactone (Aldactone, Carospir)
• Chlorthalidone
• Triamterene (Dyrenium)
• Hydrochlorothiazide (Microzide)
• Indapamide OSMOTIC DIURETICS:
• Metolazone
• Pull water into the renal tubule without sodium
LOOP DIURETICS: loss.
• Used in cases of increased cranial pressure and
• Block the chloride pump in the ascending loop acute renal failure due to shock, drug overuse, or
of Henle (high-ceiling diuretics), normally 30% trauma.
of all filtered sodium is reabsorbed, which
decreases the reabsorption of sodium and OSMOTIC DIURETICS EXAMPLES:
chloride.
• Mannitol
• Can produce a loss of fluid of up to 20 pounds a
• Glycerin
day.
• Drugs of choice when a rapid and extensive FLUID REBOUND:
diuresis is needed.
• Monitor for electrolyte imbalance. • Reflex reaction of the body to the loss of fluid or
sodium; the hypothalamus causes the release of
EXAMPLES OF LOOP DIURETICS: ADH, which retains water, and stress related to
fluid loss combines with decreased blood flow to
• Bumetanide (Bumex) the kidneys to activate the renin angiotensin
• Ethacrynic Acid (Edecrin) system, leading to further water and sodium
• Furosemide (Lasix) retention.
• Torsemide (Demadex)
VASOPRESSIN RECEPTOR ANTAGONISTS
CARBONIC ANHYDRASE INHIBITORS: (VAPTANS):
• Block the effects of carbonic anhydrase, which • Tolvaptan
slows down the movement of hydrogen ions as a • Lixivaptan
result more sodium and bicarbonate are lost in • Satavaptan
the urine.
• Used as adjuncts to other diuretics when a more CHAPTER 52: DRUGS AFFECTING THE
intense diuresis is needed. URINARY TRACT AND THE BLADDER

CARBONIC ANHYDRASE INHIBITORS: URINARY TRACT INFECTIONS:

• Acetazolamide 1. Cystitis – inflammation of the bladder, cause by

infection or irritation.
• Dorzolamide
• Methazolamide 2. Urinary Frequency – the need to void often; usually
• Brinzolamide seen in response to irritation of the bladder, age, and
inflammation.
POTASSIUM-SPARING DIURETICS:
3. Urgency – the feeling that one needs to void
• Act to cause the loss of sodium while retraining immediately, associated with infection and inflammation
potassium. May act as an aldosterone antagonist, in the urinary tract.
4. Pyelonephritis – inflammation of the pelvises of the
kidney, frequently caused by backward flow problems of
bacteria ascending the ureter.

5. Urinary Tract Anti-Infectives – act specifically within

the urinary tract to destroy bacteria.
6. Urinary Tract Antispasmodics – block the spams of
urinary tract muscles caused by various conditions.
7. Urinary Tract Analgesic – a dye that is used to relieve
that pain.
8. Bladder Protectant – pentosan polysulfate sodium
(Nipent) is used to coat or adhere to the bladder mucosal
UPPER RESPIRATORY TRACT CONDITIONS:
wall and protect it from irritation related to solutes in the
urine. 1. Common Cold – viral infection of the upper
respiratory tract initiating the release of histamine and
BENIGN PROSTATIC HYPERPLASIA (BPH) –
prostaglandins and causing an inflammatory response.
enlargement of the prostate gland, associated with age
and inflammation. 2. Seasonal Rhinitis – inflammation of the nasal cavity,
commonly called “hay fever” caused by severe reaction
DRUGS FOR TREATING BPH:
to a specific antigen.
1. Alpha Adrenergic Blockers – used to block the
3. Sinusitis – inflammation of the epithelial lining of the
constriction of arterioles in the bladder and urinary tract.
sinus cavity.
2. Finasteride – used to treat BPH by blocking
4. Pharyngitis – infection of the pharynx.
testosterone production.
5. Laryngitis – infection of the larynx.
CHAPTER 53: INTRODUCTION TO THE
RESPIRATORY SYSTEM LOWER RESPIRATORY TRACT CONDITIONS:
1. Pneumonia – inflammation of the lungs.
2. Atelectasis – collapse of once-expanded lung tissue.
3. Bronchitis – inflammation of the bronchi.
OBSTRUCTIVE PULMONARY DISEASES: 4. Expectorants – increase productive cough to clear the
airways.
1. Asthma – recurrent episodes of bronchospasm;
bronchial muscle spasm leading to narrowed or REBOUND CONGESTION – occurs when the nasal
obstructed airways. passages become congested as the drug effect wears off;
patients tend to use more drug to decrease the
2. Chronic Obstructive Pulmonary Disease (COPD) –
congestion, drug, and congestion develops, leading to
permanent, chronic obstruction of airways; leads to the abuse of the decongestant; also called “Rhinitis
obstruction of respiratory defense mechanisms and
Medicamentosa.”
physical structure.
OTHER NURSING MEASURES:
3. Cystic Fibrosis – an accumulation of copious amounts
of very thick secretions in the lungs. • Push fluids
4. Respiratory Disease Syndrome – found in premature • Increase humidity
neonates whose lungs have not fully developed and are • Cool temperatures
lacking sufficient surfactant to maintain open airways to • Avoid smoke filled area
allow for respiration. • Monitor OTC usage to prevent overdose
CHAPTER 56: INTRODUCTION TO THE
GASTROINTESTINAL SYSTEM

CHAPTER 54: DRUG ACTION ON THE

RESPIRATORY TRACT

DEFINITIONS:
1. Antitussives – block the cough reflex.
2. Decongestants – decrease the blood flow to the upper
respiratory tract and decrease the overproduction of
secretions: nasal, oral, nasal steroid.
3. Antihistamines – block the release or action of
histamine, a chemical released during inflammation that
increases secretions and narrow airways.
GASTROINTESTINAL ACTIVITIES:

• Secretion – saliva, gastrin, hydrochloric acid,

pancreatic enzymes, bile.
• Digestion
• Absorption
• Motility
LOCAL GASTROINTESTINAL REFLEXES:

• Gastroenteric reflex
• Gastrocolic reflex PROTON PUMP INHIBITORS:
• Duodenal colic reflex • Supress gastric acid secretion by specifically
• Ilegastric reflex inhibiting the hydrogen/potassium ATPase
• Intestinal-intestinal reflex enzyme system on the secretory surface of the
• Renointestinal reflex gastric parietal cells.
• Vesicointestinal reflex • Recommended for the short-term treatment of
• Somatointestinal reflex active duodenal ulcers, gastroesophageal reflux
disease, erosive esophagitis, and benign active
CENTRAL REFLEXES: gastric ulcer; for the long-term treatment of
1. Swallowing – complex reflex response to a bolus in the pathological hypersecretory conditions.
back of the throat; allows passage of the bulos into the SUCRALFATE:
esophagus and movement of ingested contents into the
GI tract. • Forms an ulcer-adherent comlex at duodenal
ulcer sites, protecting the sites against acid,
2. Vomiting – complex reflex mediated through the pepsin, and bile salts.
medulla after stimulation of the CTZ; protective reflex to
• Recommended for the short-term treatment of
remove possibly toxic substances from the stomach.
duodenal ulcers.
CHAPTER 57: DRUGS AFFECTING
MISOPROSTOL:
GASTROINTESTINAL SECRETIONS
PEPTIC ULCERS – erosion of the lining of stomach or • Prostaglandin E1, inhibits gastric acid secretion
duodenum, caused by imbalance between acid produced and increases bicarbonate and mucous
and mucous protection of the GI lining or possibly due production in the stomach, this protecting the
to infection by Helicobacterpylori Bacteria. stomach lining.
• Used to prevent NSAID-induced gastric ulcers
• Treatment – histamine H2, antagonists, proton in patients at high risk.
pump inhibitors, antipeptic agents,
prostaglandins. DIGESTIVE ENZYMES:

HISTAMINE H2 ANTAGONISTS – selectively block • Saliva substitute

histamine H2 receptors, which prevents the production • Pancreatin
of hydrochloric acid. • Pancrelipase

ANTACIDS – neutralize stomach acid, frequently

causes acid rebound, can greatly affect the absorption of
drugs from the GI tract.
 CHAPTER 58: LAXATIVE AND
ANTIDIARRHEAL AGENTS
CONSTIPATION – lower than normal evacuation of
the large intestine, which can result in increased water
absorption form the feces and lead to impactation.
DIARRHEA – more frequent than normal bowel
movements, often characterized as fluid-like and watery
because time for absorption is not allowed in the passage
of the food through the intestines.
LAXATIVES:
1. Chemical Stimulant – agent that stimulates the normal
GI reflexes by chemically irritating the lining of the GI
wall, leading to increased activity in the GI tract.
2. Bulk Stimulant – agent that increases in bulk, frequent
by osmotic pull of fluid into the feces; the increased bulk
increased bulk stretches the GI wall, causing stimulation
and increased GI movement.
3. Lubricant – agent that increases the viscosity of the
feces, making it difficult to absorb water from the bolus
and easing movement of the bolus through the intestines.
GI STIMULANTS – acts to increase GI secretions and
motility on a general level throughout the tract by
stimulating parasympathetic activity.
• Indicated when more rapid movement of GI
contents is desirable.
ANTIDIARRHEAL DRUGS:
• Slow the motility of the GI tract through direct
action on the lining of the GI tract, inhibiting
local reflexes.
• Directly act on the muscles of the GI tract to slow
activity; on CNS centers that cause GI spasm and
slowing (opium derivatives).
• Indicated for the relief of symptoms of acute and
chronic diarrhea; reduction of volume of
discharge of traveler’s diarrhea.
CHAPTER 59: EMETIC AND ANTIEMETIC
AGENTS
EMETIC AGENTS:
• Ipecac syrup – irritates the GI mucosa locally
which stimulates the CTZ to induce vomiting
within 20 minutes.
• Used to induce vomiting as a treatment for drug
overdose and certain poisonings.
CONTRAINDICATIONS TO INDUCED
VOMITING:
• Ingestion of caustic or corrosive mineral acid.
• Ingestion of volitle petroleum distillate.
• Signs of convulsions
ANTIEMETIC AGENTS:
• Phenothiazines
• Nophenothiazine – metoclopropamide
• Anticholinergic/antihistamines
• 5-HT3 receptor blockers
• Others
CHAPTER 39: INTRODUCTION TO THE
REPRODUCTIVE SYSTEM
FEMALE REPRODUCTIVE SYSTEM:
1. Ova – eggs; the female gamete; contain half of the
information needed in human nucleus.
2. Uterus – the womb; site of growth and development of
the embryo and fetus.
3. Follicle – storage site of each ovum in the ovary; allows
the ovum to grow and develop, produces estrogen and
progesterone.
4. Menopause – depletion of the female ova; results in a
lack of estrogen and progesterone.
5. Puberty – point at which the hypothalamus starts
releasing GnRF to stimulate the release of FSH and LH
and begin sexual development.
6. Corpus Luteum – remains the follicle that releases
mature ovum at ovulation; becomes an endocrine gland
producing estrogen and progesterone.
 CHAPTER 40: DRUGS AFFECTING THE
FEMALE REPRODUCTIVE SYSTEM
ESTROGENS:

• Development of the female reproductive system

and secondary sex characteristics.
• Affect the release of pituitary follicle-stimulating
hormone (FSH) and luteinizing hormone (LH).
• Causes capillary dilation, fluid retention, protein
anabolism, and thin cervical mucous.
• Conserve calcium and phosphorous and
encourage bone formation.
• Inhibit ovulation.
• Prevent postpartum breast discomfort.
INDICATIONS FOR ESTROGENS:

• Palliation of moderate to severe vasomotor

symptoms, atrophic vaginitis, and kraurosis
vulvae associated with menopause.
• Treatment of female hypogonadism, female
castration, and primary ovarian failure.
• Prevention of postpartum breast engorgement.
• Combination with progestins as oral
contraceptives.
• Postcoital contraceptive when taken in particular
sequence.
• Retardation of osteoporosis in postmenopausal
women.
• Reduce the risk of coronary artery disease in
postmenopausal women.
• As palliation in certain types of prostatic and
mammary cancers.
ESTROGEN RECEPTOR MODULATORS:
• Raloxifene
• Affects specific estrogen receptor sites to
increase bone mineral density without
stimulating the endometrium in women.
• Indicated for the treatment of postmenopausal
osteoporosis.
PROGESTINS:
• Transform the proliferative endometrium into a
secretory endometrium.
• Inhibit the secretion of FSH and LH.
• Prevent follicle maturation and ovulation.
• Inhibit uterine contractions.
• May have some anabolic and estrogenic effects.
• Indicated for contraception; as treatment of
primary and secondary amenorrhea; as
treatment for functional uterine bleeding; and in
some fertility protocols.
FERTILITY DRUGS:

• Work either directly or by stimulating the

hypothalamus to increase FSH and LH levels
and stimulate ovarian follicular development
and ova maturation.
 • Given in sequence with HCG to maintain the ADROGENIC EFFECTS:
follicle and hormone production.
a. Acne
• May be used to stimulate multiple follicle b. Edema
development for the harvesting of ova for in vitro c. Hirsutism (increased hair distribution)
fertilization. d. Deepening of the voice
• Menotropins stimulate spermatogenesis in men e. Oily skin and hair
with low sperm counts. f. Weight gain
OXYTOCINS: g. Decrease in breast size
h. Testicular atrophy
• Directly affect neuroreceptor sites to stimulate
contraction of the uterus.
• Especially effective in the gravid uterus.
• Oxytocin also stimulates the lacteal glands in the
breast to contract, promoting milk ejection in
lactating women.
• Indicated for the prevention and treatment of
uterine atony following delivery.
• Oxytocin is used in a nasal form to stimulate
milk let-down in lactating women.
ABORTIFACIENTS:

• Stimulate uterine activity, dislodging any

implanted trophoblast and preventing
implantation of any fertilized egg.
• Approved for use to terminate pregnancy 12 to
20 weeks from the date of the last menstrual
period.
TOCOLYTICS:

• Beta2-specific adrenergic agonist that mimic the

effects of the sympathetic nervous system at beta
2 sites.
• Effects include relaxation of the uterine smooth
muscle.
• Indicated for the management of preterm labor ANABOLIC STEROIDS:
in selected patients at more than 20 weeks
gestation. • Promote body tissue-building processes; reverse
catabolic or tissue-destroying processes; and
CHAPTER 41: DRUGS AFFECTING THE MALE increase hemoglobin and red blood cell mass.
REPRODUCTIVE SYSTEM
• Used to treat anemias, certain cancers, and
ANDROGENS: angioedema, to promote weight gain and tissue
repair in debilitated patients and protein
• Male sex hormones, primarily testosterone; anabolism in patients who are on long-term
produced in the testes and the adrenal glands. corticosteroid therapy.
• Indicated for the treatment of hypogonadism
and delayed puberty in males, treatment of ADVERSE EFFECTS OF ANABOLIC STEROIDS:
certain breast cancers in postmenopausal • Anabolic steroids are controlled substances.
women, the prevention of ovulation to treat
• Adverse – can be deadly when used in the
endometriosis, the prevention of postpartum
amounts needed for enhanced athletic
breast engorgement, treatment of hereditary
performance; cardiomyopathy; hepatic
angioedema.
carcinomas; personality changes; sexual
dysfunction.
PENILE ERECTILE DYSFUNCTION:

• A condition in which the corpus cavernosum

does not fill with blood to allow for penile
erection. Penile erection can be compromised
by the aging process and by vascular and
neurological conditions.
• Alprostadil
• Sildenafil (Viagra)
URINARY SYSTEM
FUNCTIONS OF THE URINARY SYSTEM: KIDNEY STRUCTURES:
• Elimination of waste products 1. Medullary Pyramids – triangular regions of tissues in
o Nitrogenous wastes the medulla.
o Toxins
o Drugs 2. Renal Columns – extensions of cortex-like material
• Regulate aspects of homeostasis inward
o Water balance 3. Calyces – cup-shaped structures that funnel urine
o Electrolytes towards the renal pelvis.
o Acid-base balance in the blood
o Blood pressure BLOOD FLOW IN THE KIDNEYS:
o Red blood cell production
o Activation of vitamin D
ORGANS OF THE URINARY SYSTEM:

• Kidneys
• Uterus
• Urinary bladder
• Urethra
LOCATION OF THE KIDNEYS:
• Against the dorsal body wall.
• At the level of T12 to L3.
• The right kidney is slightly lower than the left.
• Attached to uterus, renal blood tissues, and
nerves at renal hilus.
• Atop each kidney is an adrenal gland.
COVERINGS OF THE KIDNEYS:
1. Renal capsule – surrounds each kidney.
2. Adipose capsule – surrounds the kidney.
• Provides protection to the kidney.
• Helps keep the kidney in its correct location.
REGIONS OF THE KIDNEY:
1. Renal Cortex – outer region.
2. Renal Medulla – inside the cortex.
3. Renal Pelvis – inner collecting tube.
NEPHRONS:
• The structural and functional units of the
kidneys.
• Responsible for forming urine.
• Main structures of the nephrons.
o Glomerulus
o Renal tubule
GLOMERULUS:
• A specialized capillary beds.
• Attached to arterioles on both sides (maintains
high pressure).
o Large afferent arteriole.
o Narrow efferent arteriole.
• Capillaries are covered with podocytes from the
renal tubule.
• The glomerulus sits within a glomerular capsule
(the first part of the renal tubule).
RENAL TUBULE:
• Glomerular (Bowman’s) capsule.
• Proximal convoluted tubule.
• Loop of Henle.
• Distal convoluted tubule.
TYPES OF NEPHRONS: • Most reabsorption occurs in the proximal
convoluted tubule.
1. Cortical Nephrons
3. Secretion
• Located entirely in the cortex.
• Includes most nephrons. MATERIALS NOT REABSORBED:
1. Nitrogenous waste products

• Urea
• Uric acid
• Creatinine
2. Excess water

2. Juxtamedullary Nephrons FORMATION OF URINE:

• Found at the boundary of the cortex and

medulla.
PERITUBULAR CAPILLARIES:

• Arise from efferent arteriole of the glomerulus.

• Normal. Low pressure capillaries.
• Attached to a venule.
• Cling close to the renal tubule.
• Reabsorb (reclaim) some substances from
collecting tubes.
URINE FORMATION PROCESSES: CHARACTERISTICS OF URINE USED FOR
MEDICAL DIAGNOSIS:

• Colored somewhat yellow due to the pigment

urochrome (from the destruction of
hemoglobin) and solutes.
• Sterile
• Slightly aromatic.
• Normal pH of around 6.
• Specific gravity of 1.001 to 1.035.
URETERS:

• Slender tubes attaching the kidney to the

1. Filtration – nonselective passive process. bladder.
• Water and solutes smaller than proteins are o Continuous with the renal pelvis.
forced through capillary walls. o Enter posterior aspect of the bladder.
• Blood cells cannot pass out to the capillaries. • Runs behind the peritoneum.
• Filtrate is collected in the glomerular capsule • Peristalsis aids gravity in urine transport.
and leaves via the renal tubule. URINARY BLADDER:
2. Reabsorption • Smooth, collapsible, muscular sac.
• The peritubular capillaries reabsorb several • Temporarily stores urine.
materials.
o Some water
o Glucose
o Amino acids
o Ions
• Some reabsorption is passive, most is active.
 • Trigone – three openings. DISTRIBUTION OF BODY FLUID:
o Two from the uterus.
• Intracellular fluid (inside cells).
o One to the urethra.
• Extracellular fluid (outside cells).
URINARY BLADDER WALL: o Interstitial fluid
o Blood plasma
• Three layers of smooth muscle (detrusor
muscle). THE LINK BETWEEN WATER AND SALT:
• Mucosa made of transitional epithelium.
• Changes in electrolyte balance causes water to
• Walls are thick and folded in an empty bladder.
move from one compartment to another.
• Bladder can expand significantly without
• Alters blood volume and blood pressure.
increasing internal pressure.
• Can impair the activity of cells.
URETHRA:
MAINTAINING WATER BALANCE:
• Thin-walled tube that carries urine from the
• Water intake must equal water output.
bladder to the outside of the body by peristalsis.
• Release of urine is controlled by two sphincters. • Sources for water intake.
o Internal urethral sphincter (involuntary) o Ingested foods and fluids.
o External urethral sphincter (voluntary) o Water produced from metabolic
processes.
URETHRA GENDER DIFFERENCES: • Sources for water output.
o Vaporization out of the lungs.
• Length o Lost in perspiration.
o Females – 3 to 4 cm (1 inch)
o Leaves the body in the feces.
o Males – 20 cm (8 inches)
o Urine production.
• Location • Dilute urine is produced if water intake is
o Females – along wall of the vagina.
excessive.
o Males – through the prostate and penis.
• Less urine (concentrated) is produced if large
• Function
amounts of water are lost.
o Females – only carries urine.
• Proper concentrations of various electrolytes
o Males – carries urine and is a
must be present.
passageway for sperm cells.
REGULATION OF WATER AND ELECTROLYTE
MICTURITION (VOIDING):
REABSORPTION:
• Both sphincter muscles must open to allow
• Regulation is primarily by hormones.
voiding.
• Antidiuretic hormone (ADH) prevents excessive
• The internal urethral sphincter is relaxed after
water loss in urine.
stretching of the bladder.
• Aldosterone regulates sodium ion content of
• Activation is from an impulse sent to the spinal
extracellular fluid.
cord and then back via the pelvic splanchnic
nerves. • Triggered by the rennin-angiotensin mechanism.
• The external urethral sphincter must be • Cells in the kidneys and hypothalamus are active
voluntarily relaxed. monitors.

MAINTAINING WATER BALANCE:

• Normal amount of water in the human body.

o Young adult females – 50%
o Young adult males – 60%
o Babies – 75%
o Old age – 45%
• Water is necessary for many body functions and
levels must be maintained.
MAINTAINING ACID-BASE BALANCE IN AGING AND THE URINARY SYSTEM:
BLOOD:
• There is a progressive decline in urinary
• Blood pH must remain between 7.35 and 7.45 function.
to maintain homeostasis. • The bladder shrinks with aging.
o Alkalosis – pH above 7.45 • Urinary retention is common in males.
o Acidosis – pH below 7.35
• Most ions originate as by-products of cellular THE REPRODUCTIVE SYSTEM
metabolism. • Gonads – primary sex organs.
• Most acid-base balance is maintained by the o Testes in males
kidneys. o Ovaries in females
• Other acid-base controlling systems. • Gonads produces gametes (sex cells) and secrete
o Blood buffers hormones.
o Respiration o Sperm – male gametes
THE BICARBONATE BUFFER SYSTEM: o Ova (eggs) – female gametes

• Mixture of Carbonic Acid (H2CO3) and MALE REPRODUCTIVE SYSTEM:

Sodium Bicarbonate (NaHCO3). • Testes
• Bicarbonate Ions (HCO3-) react with strong • Duct system
acids to change them to weak acids. o Epididymis
• Carbonic acid dissociates in the presence of a o Ductus deferens
strong base to form a weak base and water. o Urethra
RESPIRATORY SYSTEM CONTROLS OF ACID- • Accessory organs
BASE BALANCE: o Seminal vesicle
o Prostate gland
• Carbon dioxide in the blood is converted to o Bulbourethral gland
bicarbonate ion and transported in the plasma. • External genitalia
• Increases in hydrogen ion concentration o Penis
produces more carbonic acid. o Scrotum
• Excess hydrogen ion can be blown off with the
release of carbon dioxide from the lungs.
• Respiratory rate can rise and fall depending on
changing blood pH.
RENAL MECHANISM OF ACID-BASE BALANCE:

• Excrete bicarbonate ions if needed.

• Conserve or generate new bicarbonate ions if
needed.
• Urine pH varies from 4.5 to 8.0.
DEVELOPMENTAL ASPECTS OF THE URINARY
SYSTEM:
• Functional kidneys are developed by the third
month.
• Urinary system of a newborn:
o Bladder is small
o Urine cannot be concentrated
• Control of the voluntary urethral sphincter does
not start until age 18 months.
• Urinary infections are the only common
problems before old age.
TESTES:
• Each lobule contains one to four seminiferous
tubules.
o Tightly coiled structures
o Function as sperm-forming factories
o Empty sperm into the rete testis.
• Sperm travels through the rete testis to the
epididymis.
• Interstitial cells produce androgens such as
testosterone.
EPIDIDYMIS:
• Comma-shaped, tightly coiled tube.
• Found on the superior part of the testes and
along the posterior lateral side.
• Functions to mature and store sperm cells (at
least 20 days).
 • Expels sperm with the contraction of muscles in
the epididymis walls to the vas deferens.
DUCTUS DEFERENS (VAS DEFERENS):
• Carries sperm from the epididymis to the
ejaculatory duct.
• Passes through the inguinal canal and over the
bladder.
• Moves sperm by peristalsis.
• Spermatic cord – ductus deferens, blood vessels,
and nerves in a connective tissue sheath.
• Ends in the ejaculatory duct which unites with
the urethra.
• Vasectomy – cutting of the ductus deferens at the
level of the testes to prevent transportation of
sperm.
URETHRA:
• Extends from the base of the urinary bladder to
the tip of the penis.
• Carries both urine and sperm.
• Sperm enters from the ejaculatory duct.
REGIONS OF THE URETHRA:
1. Prostatic Urethra – surrounded by prostate.
2. Membranous Urethra – from prostatic urethra to
penis.
3. Spongy (penile) Urethra – runs the length of the penis.
SEMINAL VESICLES:
• Located at the base of the bladder.
• Produces a thick, yellowish secretion (60% of
semen).
o Fructose (sugar)
o Vitamin C
o Prostaglandins
o Other substances that nourish and
activate sperm.
PROSTATE GLAND:
• Encircles the upper part of the urethra.
• Secretes a milky fluid.
o Helps to activate sperm.
o Enters the urethra through several small
ducts.
BULBOURETHRAL GLANDS:
• Pea-sized gland inferior to the prostate.
• Produces a thick, clear mucus
o Cleanses the urethra of acidic urine.
o Serves as a lubricant during sexual
intercourse.
o Secreted into the penile urethra.
SEMEN:
• Mixture of sperm and accessory gland
secretions.
• Advantages of accessory gland secretions:
o Fructose provides energy for sperm
cells.
o Alkalinity of semen helps neutralize the
acidic environment of vagina.
o Semen inhibits bacterial multiplication.
o Elements of semen enhance sperm
motility.
EXTERNAL GENITALIA:
1. Scrotum – divided sac of skin outside the abdomen.
• Maintains testes at 3 Celsius lower than normal
body temperature to protect sperm viability.
2. Penis – delivers sperm into the female reproductive
tract.
• Regions of the penis:
o Shaft
o Glans penis (enlarged tip)
o Prepuce (foreskin)
▪ Folded cuff of skin around
proximal end.
▪ Often removed by
circumcision.
• Internally, there are three areas of spongy
erectile tissue around the urethra.
SPERMATOGENESIS:
• Production of sperm cells.
• Begins at puberty and continues throughout life.
• Occurs in the seminiferous tubules.
PROCESSES OF SPERMATOGENESIS:
1. Spermatogonia (stem cells) – undergo rapid mitosis to
produce more stem cells before puberty.
• Follicles stimulate hormone (FSH) modifies
spermatogonia division.
o One cell produced is a stem cell.
o The other cell produced becomes a
primary spermatocyte.
• Primary spermatocytes undergo meiosis.
• Haploid spermatids are produced.
2. Spermiogenesis – late spermatids are produced with
distinct regions.
• Head – contains DNA covered by the acrosome.
o Midpiece
o Tail
• Sperm cells result after maturing of spermatids.
 • Spermatogenesis takes 64 to 72 days. FEMALE REPRODUCTIVE SYSTEM:

• Ovaries
• Duct system
o Uterine tubes (fallopian tubes)
o Uterus
o Vagina
• External genitalia
OVARIES:

• composed of ovarian follicles (sac-like

structures).
• Structure of an ovarian follicle:
o Oocyte
o Follicular cells
ANATOMY OF A MATURE SPERM CELL:
OVARIAN FOLLICLE STAGES:
• The only human flagellated cell.
1. Primary Follicle – contains an immature oocyte.
• DNA is found in the head.
2. Graafian (vesicular) follicle – growing follicle with a
maturing oocyte.
3. Ovulation – when the egg is mature, the follicle
ruptures.

• Occurs about every 28 days.

• The ruptured follicle is transformed into a
corpus luteum.
SUPPORT FOR OVARIES:
TESTOSTERONE PRODUCTION:
1. Suspensory ligaments – secure ovary to lateral walls of
• The most important hormone of the testes. the pelvis.
• Produced in interstitial cells.
2. Ovarian ligaments – attach to uterus.
FUNCTIONS OF TESTOSTERONE:
3. Broad ligament – a fold of the peritoneum, encloses
• Stimulates reproductive organ development. suspensory ligament.
• Underlies sex drive.
• Causes secondary sex characteristics.
• Deepening of voice, increased hair growth,
enlargement of skeletal muscles and thickening
of bones.
REGULATION OF MALE ANDROGENS (SEX
HORMONES):
UTERINE (FALLOPIAN) TUBES:

• Receive the ovulated oocyte.

• Provide a site for fertilization.
• Attaches to the uterus.
• Does not physically attach to the ovary.
• Supported by the broad ligament.
UTERINE TUBE FUNCTION:

• Fimbriae – finger-like projections at the distal

end that receive the oocyte.
• Fertilization occurs inside the uterine tube.
 • Cilia inside the uterine tube slowly move the
oocyte towards the uterus (takes 3 to 4 days).
UTERUS:
• Located between the urinary bladder and
rectum.
• Hollow organ.
• Functions of the uterus.
o Receives a fertilized egg.
o Retains the fertilized egg.
o Nourishes the fertilized egg.
REGIONS OF THE UTERUS:
1. Body – main portion.
2. Fundus – area where uterine tube enters.
3. Cervix – narrow outlet that protrudes into the vagina.
WALLS OF THE UTERUS:
1. Endometrium – allows for implantation of a fertilized
egg.
OOGENESIS:
• The total supply of eggs is present at birth.
• Ability to release eggs begin at puberty.
• Reproductive ability ends at menopause.
• Oocytes are matured in developing ovarian
follicles.
• Primary oocytes are inactive during puberty.
• Follicle stimulating hormone (FSH) causes some
primary follicles to mature.
• Meiosis starts inside maturing follicle.
• Produces a secondary oocyte and the first polar
body.
• Meiosis is completed after ovulation only if
sperm penetrates.
• Two additional polar bodies are produced.

• Inner layer.
• Sloughs off if no pregnancy occurs (menses).
2. Myometrium – middle layer of smooth muscle.
3. Serous Layer – outer visceral peritoneum.
VAGINA:
OOGONIA:
• Extends from cervix to exterior of body.
• Behind bladder and in front of rectum. • Female stem cells found in a developing fetus.
• Serves as the birth canal. • Oogonia undergo mitosis to produce primary
oocytes.
• Receives the penis during sexual intercourse.
• Primary oocytes are surrounded by cells that
• Hymen – partially closes the vaginal until it is
form primary follicles in the ovary.
ruptured.
• Oogonia no longer exist by the time of birth.
EXTERNAL GENITALIA (VULVA)
MENSTRUAL (UTERINE) CYCLE:
1. Mons Pubis – fatty area overlying the pubic symphysis.
• Cyclic changes of the endometrium.
• Covered with pubic hair after puberty. • Regulated by cyclic production of estrogen and
progesterone.
2. Labia – skin folds.
STAGES OF THE MENSTRUAL CYCLE:
• Labia majora
• Labia minora 1. Menses – functional layer of the endometrium is
sloughed.
3. Vestibule – contains opening of the urethra and the
greater vestibular glands (produce mucus). 2. Proliferative Stage – regeneration of functional layer.

• Enclosed by labia majora. 3. Secretory Stage – endometrium increases in size and

readies for implantation.
4. Clitoris – contains erectile tissue.

• Corresponds to the male penis.

HORMONAL CONTROL OF THE OVARIAN
AND UTERINE CYCLES:
HORMONE PRODUCTION BY THE OVARIES:
1. Estrogen
• Produced by follicle cells.
• Causes secondary sex characteristics.
• Enlargement of accessory organs.
• Development of breasts.
• Appearance of pubic hair.
• Increase in fat beneath the skin.
• Widening and lightening of the pelvis.
• Onset of menses.
2. Progesterone
• Produced by the corpus luteum.
• Production continues until LH diminishes in the
blood.
• Helps maintain pregnancy.
MAMMARY GLANDS:
• Present in both sexes, but only function in
females.
o Modified sweat glands.
• Function is to produce milk.
• Stimulated by sex hormones (mostly estrogen) to
increase in size.
ANATOMY OF MAMMARY GLANDS:
1. Areola – central pigmented area.
2. Nipple – protruding central area of areola.
3. Lobes – internal structures that radiate around nipple.
4. Alveolar Glands – clusters of milk producing glands
within lobules.
5. Lactiferous Ducts – connect alveolar glands to nipple.
STAGES OF PREGNANY AND DEVELOPMENT:
1. Fertilization
2. Embryonic Development
3. Fetal Development
4. Childbirth
FERTILIZATION:
• The oocyte is viable for 12 to 24 hours after
ovulation.
• Sperm are viable for 12 to 48 hours after
ejaculation.
• Sperm cells must make their way to the uterine
tube for fertilization to be possible.
MECHANISM OF FERTILIZATION:
• Membrane receptors on a oocyte pulls in the
head of the first sperm cell to make contact.
• The membrane of the oocyte does not permit a
second sperm head to enter.
• The oocyte then undergoes its second meiotic
division.
• Fertilization occurs when the genetic material of
a sperm combines with that of an oocyte to form
a zygote.
THE ZYGOTE:
• The first cell of a new individual.
• The result of the fusion of DNA from sperm and
egg.
• The zygote begins rapid mitotic cell divisions.
• The zygote stage is in the uterine tube, moving
toward the uterus.
THE BLASTOCYST:
• Ball-like circle of cells.
 • Begins at about 100 cell stage. FUNCTIONS OF THE PLACENTA:
• Secretes human chorionic gonadotropin (hCG)
• Forms a barrier between mother and embryo
to produce the corpus luteum to continue
(blood is not exchanged).
producing hormones.
• Delivers nutrients and oxygen.
• Functional areas of the blastocyst.
o Trophoblast – large fluid-filled sphere. • Removes waste from embryonic blood.
o Inner cell mass. • Becomes an endocrine organ (produces
• Primary germ layers are eventually formed: hormones) and takes over the corpus luteum.
o Ectoderm – outside layer. o Estrogen, progesterone, and other
hormones that maintain pregnancy.
o Mesoderm – middle layer.
o Endoderm – inside layer. THE FETUS (BEGINNING OF THE WEEK):
• The late blastocyst implants in the wall of the
uterus (by day 14). • All organ systems are formed by the end of the
eighth week.
DERIVATIVES OF GERM LAYERS: • Activities of the fetus are growth and organ
1. Ectoderm specialization.
• A stage of tremendous growth and change in
• Nervous system appearance.
• Epidermis of the skin
THE EFFECTS OF PREGNNACY ON THE
2. Endoderm MOTHER:

• Mucosae • Pregnancy – period of conception until birth.

• Glands • Anatomical changes:
o Enlargement of the uterus.
3. Mesoderm o Accentuated lumbar curvature.
• Everything else o Relaxation of the pelvic ligaments and
pubic symphysis due to production of
DEVELOPMENT FROM OVULATION TO relaxing.
IMPLANTATION: • Psychological changes (Gastrointestinal system):
o Morning sickness is common due to
elevated progesterone.
o Heartburn is common because of organ
crowding fetus.
o Constipation is caused by declining
motility of the digestive tract.
• Psychological changes (Urinary system):
o Kidneys have additional burden and
produce more urine.
DEVELOPMENT AFTER IMPLANTATION:
o The uterus compresses the bladder.
• Chronic villi (projections of the blastocyst) • Psychological changes (Respiratory system):
develop. o Nasal mucosa becomes congested and
• Cooperate with cells of the uterus to form the swollen.
placenta. o Vital capacity and respiratory rate
• The embryo is surrounded by the amnion (a increase.
fluid filled sac). • Psychological changes (Cardiovascular system):
• An umbilical cord forms to attach the embryo to o Body water arises.
the placenta. o Blood volume increase by 25 to 40
percent.
o Blood pressure and pulse increase.
o Varicose veins are common.
CHILDBIRTH (PARTITION):

• Labor – the series of events that expel the infant

from the uterus.
• Initiation of labor:
 o Estrogen levels rise.
o Uterine contraction begins.
o The placenta releases prostaglandins.
o Oxytocin is released by the pituitary.
o Combination of these hormones
produces contractions.
• The first two menses usually occur about 2 years
after the start of puberty.
• Most women reach peak reproductive ability in
their late 20s.
• Menopause occurs when ovulation and messes
cease entirely.
o Organs stop functioning as endocrine
organs.
• There is a no equivalent of menopause in males,
but there is a steady decline in testosterone.

STAGES OF LABOR:
1. Dilation – cervix becomes dilated.

• Uterine contractions begin and increase.

• The amnion ruptures.
2. Expulsion – infant passes through the cervix and
vagina.

• Normal delivery is headfirst.

3. Placental Stage – delivery of the placenta.

DEVELOPMENTAL ASPECTS OF THE

REPRODUCTIVE SYSTEM:

• Gender is determined at fertilization.

o Males have XY sex chromosomes.
o Females have XX sec chromosomes.
• Gonads do not begin to form until the eighth
week.
• Testes form in the abdominal cavity and
descend to the scrotum one month before birth.
• The determining factor for gonad differentiation
is testosterone.
• Reproductive system organs do not function
until puberty.
• Puberty usually begins between ages 10 and 15.