BODY DEALS WITH PH CHANGES BY 3 MECHANISMS:

Buffers: 1st line of defense, immediate response

Bicarbonate buffer (ECF)

Protein buffers (ICF)

Hemoglobin (ICF)

Phosphate (ICF)

Ventilation: 2nd line of defense, can handle ~ 75% of

most pH disturbances.

Renal regulation of H+ & HCO3: final defense, slow but

very effective.

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 ACID BASE DISORDERS

Respiratory acidosis:
Metabolic acidosis:
 Hypoventilation.
 Gain of fixed acid or loss of HCO3-.
 Accumulation of CO2.
 Plasma HCO3- decreases.
 pH decreases.
 pH decreases.

Respiratory alkalosis:
Metabolic alkalosis:
 Hyperventilation.
 Loss of fixed acid or gain of HCO3-.
 Excessive loss of CO2.
 Plasma HCO3- increases.
 pH increases.
 pH increases.

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 ACID BASE IMBALANCE

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 ALGORITHM USED TO DESCRIBE ACID-
BASE DISORDERS

• PaCO2 defines the presence of respiratory disorders;

plasma [HCO3−] defines the presence of metabolic disorders.

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RESPIRATORY ROLE IN ACID BASE BALANCE

Metabolic alkalosis:
Generally respiratory system affects the CO2
concentration in plasma. Cause: Prolonged vomition, HCl acid from
the stomach is lost and this effect elevates
That is: it eliminates or conserves CO2 in the body. blood HCO3 level.
For example during :
Comp: The respiratory system inhibits
Metabolic acidosis: respiration (causes lower breathing rate)

Cause: H+ accumulation in blood from food Hypoventilation causes retention of CO2 and
causes the pH to come to normal
Comp: elimination of CO2 by hyperventilation.

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METABOLIC ACIDOSIS CAUSES AND COMPENSATION

Starvation: ketoacidosis mostly fats burn instead Compensation of Metabolic acidosis

of CHO
Is usually done through respiratory means .

a.hyperventilation causes washout of CO2 and decreases H+

Hypoxia: decreased O2, thus glycolysis indirectly from body fluids
dominates and lactic acid is generated

H + HCO3 = H2CO3= CO2 + H2O

Severe diaharria: large amounts of HCO3 is lost,
acid dominates (the reaction goes to the right and CO2 is eliminated)

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RESPIRATORY ACIDOSIS, CAUSES AND
COMPENSATION

Cause of respiratory acidosis (hypoventilation) Compensation

The lung fails to expire CO2 produced by By the kidney:

metabolism.
It increases the reabsorption of HCO3
A lot of CO2 accumulates making the pH <7.4

a. Respiratory depression (e.g., drugs, sedatives cause

hypoventilation) HCO3 raises the pH back to normal.

b. Pulmonary diseases that cause hypoventilation

Emphysema, asthma etc.

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METABOLIC ALKALOSIS, CAUSES AND COMPENSATION

Metabolic alkalosis: Compensation of metabolic alkalosis:

Cause: Increased loss H+ or an increase The respiratory system inhibits respiration (causes
in HCO3 production in the body lower breathing rate)

a. Prolonged vomiting: HCl acid from

the stomach is lost and this effect
elevates blood HCO3 level. Hypoventilation causes retention of CO2 and
causes the pH to come to normal
b. Hyper-aldosteronism: causes
increase HCO3 reabsorption increases

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 RESPIRATORY ALKALOSIS

Respiratory alkalosis

Causes: Compensation

Excessive removal of CO2 Kidney results in a loss of HCO3 in urine

from the body through until pH becomes normal
hyperventilation.

This causes a drop in PCO2

level in the body

High altitude hypoxia, Anxiety,

etc *

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Urinary tract
 Urine formed by the nephrons collect in renal pelvis and flows down to ureter > then to
bladder > regulated by internal and external sphincter > urethra > and finally, expelled to
outside.

Renal pelvis

The major function of the renal pelvis is to act as a funnel for urine flowing to the ureter.

The renal pelvis represents the funnel-like dilated proximal part of the ureter.

It is the point of convergence of two or three major calices.

Each renal papilla is surrounded by a branch of the renal pelvis called a calyx.

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 URETERS
Urine is collected in the renal pelvis (or pyelum),
which connects to the ureters, which carry urine to the
bladder.

The ureters are about 200 to 250 mm long.

Smooth muscular tissue in the walls of the ureters

peristaltically force the urine downward.

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 URINARY BLADDER

The urinary bladder is a hollow muscular organ shaped like a balloon.

It is located in the pelvic fossa and held in place by ligaments attached to the pelvic
bones.
The bladder stores urine up to 500 ml of urine comfortably for 2 to 5 hours.
Sphincters (circular muscles) regulate the flow of urine from the bladder.
 Internal urethral sphincter: in the beginning of urethra smooth muscle – it is not under our voluntary control.

 External urethral sphincter: skeletal muscle – we can control it.

The detrusor muscle is a layer of the urinary bladder wall, made up of smooth muscle
fibers arranged in inner and outer longitudinal layers and a middle circular layer.

Contraction of the detrusor muscle causes the bladder to expel urine through the
urethra.

Problems with this muscle can lead to incontinence.

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 URETHRA:
Extends from the base of the bladder to the outside world.

Anatomical differences of male and female urethras:

 Female: 4-6 cm short
 Male: 18-20 cm long

Male urethra has both urinary function and reproductive

function.
 It carries urine and semen.

Female urethra has only urinary function and it carries only urine.

So, male urethra is structurally and functionally different from female urethra.

Urethral sphincters:
 Internal Urethral sphincters.
 External Urethral sphincters.

The external urethral sphincter is a striated skeletal muscle that allows voluntary control over
urination.

In males the internal and external urethral sphincters are more powerful, able to retain urine for
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twice as long as females.
 URINATION
(MICTURITION)
The process of disposing urine from the urinary bladder
through the urethra to the outside of the body.

The process of urination is usually under voluntary control.

Urinary incontinence is the inability to control urination,

Urinary retention refers to the inability to urinate.

Enuresis nocturnal = incontinence during the night

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 MICTURITION REFLEX
Process of urination or micturition coordinated by micturition reflex.

Stretch receptors stimulated as bladder fills.

Increased impulses in afferent sensory fibers:

 Brings parasympathetic motor neurons in sacral spinal cord to threshold.

 Stimulates interneurons to relay sensation to cerebral cortex (conscious awareness).

Urge to urinate when bladder contains 200-500 mL of urine.

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 MICTURITION REFLEX

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 A. Urine in bladder (400-500 ml). Urine stimulates Stretch
receptors > AP through sensory neurons to > sacral spinal cord
> reflex back through PSN to bladder > bladder is contracted
> urine released through urethra.
But at the same time , external urinary sphincter relaxes (through
decreased motor signal from sacral)
B. Micturition center is found in Pons and cerebrum. So, impulses
also ascend to Micturition center and by reflex descending signals
to sacral portion occurs where modification of the reflex occurs.
E.g. in children (2-3 years), the ability to voluntarily inhibit
*

urination is not matured.

In adults, higher centers can inhibit PN to some degree.

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CONTROL OF THE BLADDER

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Nerve supply to urinary bladder and urethra

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 A. Bladder
at rest

B. Bladder
Micturi
tion

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 FUNCTIONS OF NERVES
SUPPLYING URINARY BLADDER
AND SPHINCTERS

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 PROPERTIES OF URINE

Volume : 1,000 to 1,500 mL/day Osmolarity : 1,200 mOsm/L

 Color : Normally, straw colored
Reaction : Slightly acidic with pH of 4.5 to 6  Odor : Fresh urine has light aromatic odor.

 If stored for some time, the odor becomes stronger due to bacterial
Specific gravity : 1.010 to 1.025. decomposition.

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