Deze samenvatting is gebaseerd op de lessen van L. Missiaen en de slides die hij tijdens zijn lessen gebruikt. L. Missiaen dicteert letterlijk wat je moet opschrijven en wat je moet kennen dus als je dit document hebt, moet je absoluut niet meer naar de les gaan. Ook de tekeningen zijn verwerkt in ...
Fysiologie van de mens – L. Missiaen
Hoofdstuk 1: De nier ...................................................................................................................................... 5
1: Fysiologie van de nieren .................................................................................................................................. 5
1.1: Perfusie: bevloeiing van de nieren .......................................................................................................... 5
A. Anatomie van de nier ............................................................................................................................. 5
B. Detectie van het extracellulair volume .................................................................................................. 6
C. Regeling: wat regelt de perfusie van de nieren? .................................................................................... 8
2: filtratie .......................................................................................................................................................... 10
A. Filter ......................................................................................................................................................... 10
B. Starlingkrachten ....................................................................................................................................... 13
C. Regeling van de filtratie ............................................................................................................................ 14
D. Meting GFR............................................................................................................................................... 16
3. Reabsorptie en secretie ................................................................................................................................. 18
4. Mictie (het urineren) ..................................................................................................................................... 18
5. Extracellulaire pH .......................................................................................................................................... 20
A. Aanvoer van zuren en basen .................................................................................................................... 21
Zuren ........................................................................................................................................................ 21
Basen ........................................................................................................................................................ 22
B. Excretie van zuren en basen: excretie wordt geregeld ............................................................................ 22
Excretie van vluchtige zuren .................................................................................................................... 22
Excretie van niet-vluchtige zuren: HCl ..................................................................................................... 23
-
Excretie van base HCO3 ........................................................................................................................... 24
C. Zuur-base stoornissen waarbij de pH afwijkt van 7,40............................................................................. 24
6. Extracellulaire osmolaliteit (hoofdstuk over water) ...................................................................................... 25
A. Renale H2O-excretie ................................................................................................................................ 27
B. Dorst (inname van dranken) ..................................................................................................................... 28
+
7. Extracellulair volume (hoofdstuk over Na )................................................................................................... 28
Regeling van de Natrium-excretie ................................................................................................................ 29
Mechanisme ................................................................................................................................................. 30
Belang van regeling: ..................................................................................................................................... 31
Tijd ................................................................................................................................................................ 31
+
8. Extracellulaire [K ] ......................................................................................................................................... 31
A. Cellulaire opname .................................................................................................................................... 32
+
B. Renale K -excretie .................................................................................................................................... 33
2+
9. Extracellulaire [Ca ] ..................................................................................................................................... 35
A. Vitamine D ................................................................................................................................................ 35
Aanmaak Vitamine D ................................................................................................................................ 35
Functie van actief vitamine D .................................................................................................................. 36
Pathologie ................................................................................................................................................ 36
Parathyreoïdhormoon (PTH) ........................................................................................................................ 37
Hoofdstuk 2: Ademhaling ............................................................................................................................. 38
1. Anatomie....................................................................................................................................................... 38
A. Omgevingslucht ........................................................................................................................................ 38
B. Indeling van de luchtwegen...................................................................................................................... 39
C. Functie van verschillende zones ............................................................................................................... 39
2. Ventilatie ....................................................................................................................................................... 40
A. Statische dynamica (wanneer lucht niet stroomt) ................................................................................... 40
Longvolumes ............................................................................................................................................ 41
1
, Geïsoleerde long ...................................................................................................................................... 42
Retractiekracht .................................................................................................................................... 42
Expansiekracht ..................................................................................................................................... 43
Geïsoleerde thoraxwand .......................................................................................................................... 44
Thorax (long + thoraxwand) ..................................................................................................................... 45
Ontspannen ademspieren ................................................................................................................... 45
Actieve ademspieren ........................................................................................................................... 46
B. Dynamische dynamica (tijdens het stromen van lucht) ........................................................................... 47
Drukgradiënt ............................................................................................................................................ 47
V = ∆PRAW .................................................................................................................................................. 47
V = ∆PRAW met RAW: airway resistance ...................................................................................................... 48
Luchtwegenweerstand ............................................................................................................................. 49
Oorzaak ................................................................................................................................................ 49
Beïnvloeding ........................................................................................................................................ 50
3. longcirculatie................................................................................................................................................. 52
A. Vasculaire weerstand ............................................................................................................................... 53
Grootte van de weerstand ....................................................................................................................... 53
Beïnvloeding van weerstand .................................................................................................................... 53
B. Functie van de longcirculatie .................................................................................................................... 57
4. Diffusie .......................................................................................................................................................... 57
A. Luchtwegen .............................................................................................................................................. 57
PACO2 ......................................................................................................................................................... 58
PAO2 .......................................................................................................................................................... 58
B. Lucht-bloedbarrière .................................................................................................................................. 59
Anatomie .................................................................................................................................................. 59
Diffusiewet ............................................................................................................................................... 59
Transport van O2 in de longen ................................................................................................................. 60
Stap 1: wat gebeurt er met de partiële druk van zuurstof in het bloed? ............................................ 60
Stap 2: wat gebeurt er met de zuurstofconcentratie in het bloed? .................................................... 61
CO2 ........................................................................................................................................................... 62
Stap 1: wat gebeurt er met de partiële druk van CO2? ........................................................................ 62
Stap 2: wat gebeurt er met de CO2-concentratie in het bloed? .......................................................... 62
C. Weefsels (bv. spieren in onderste ledematen .......................................................................................... 63
O2 –transport in de weefsels .................................................................................................................... 63
Stap 1: wat gebeurt er met de partiële druk van zuurstof .................................................................. 63
Stap 2: wat gebeurt er met de zuurstofconcentratie in het bloed? .................................................... 63
CO2-trasport in de weefsels ..................................................................................................................... 63
Stap 1: wat gebeurt er met de partiële druk van CO2 (PCO2) ................................................................ 64
Stap 2: wat gebeurt er met de CO2-concentratie ................................................................................ 64
5. Controle ......................................................................................................................................................... 64
A. Centrale patroongenerator ...................................................................................................................... 64
B. Regeling van centrale patroongenerator ................................................................................................. 64
6. Ademhaling onder stress............................................................................................................................... 66
A. Inspanning ................................................................................................................................................ 66
Ventilatie .................................................................................................................................................. 66
O2-opname ............................................................................................................................................... 67
B. Grote hoogte ............................................................................................................................................ 67
Hoofdstuk 3. Voortplanting .......................................................................................................................... 69
1. Niet-zwangere vrouw .................................................................................................................................... 69
A. Gonadotropinen ....................................................................................................................................... 69
Wat? ......................................................................................................................................................... 69
Welke? ..................................................................................................................................................... 69
Waar worden ze gevormd? ...................................................................................................................... 69
2
, Stimulus.................................................................................................................................................... 70
Regeling .................................................................................................................................................... 70
B. Follikels ..................................................................................................................................................... 71
C. Cyclus ........................................................................................................................................................ 72
Folliculaire fase ........................................................................................................................................ 73
Luteale fase .............................................................................................................................................. 76
D. Uterus ....................................................................................................................................................... 77
Endometrium: slijmvlies van de baarmoeder .......................................................................................... 77
Myometrium: spierlaag van de baarmoeder ........................................................................................... 79
Cervix = baarmoederhals ......................................................................................................................... 80
E. Oudere vrouw ........................................................................................................................................... 80
Endocrinologie (hormonale veranderingen) ............................................................................................ 80
Gevolgen .................................................................................................................................................. 82
2. Zwangere vrouw ........................................................................................................................................... 83
A. Endocrinologie.......................................................................................................................................... 83
Humaan choriongonadotropine (hCG) ..................................................................................................... 83
Progesteron .............................................................................................................................................. 85
Oestrogenen............................................................................................................................................. 86
Relaxine .................................................................................................................................................... 87
B. Lichamelijke veranderingen ..................................................................................................................... 87
Ademhaling: hoe verandert de ademhaling bij een zwangere vrouw? ................................................... 87
Nieren....................................................................................................................................................... 88
Bloed ........................................................................................................................................................ 89
Circulatie .................................................................................................................................................. 90
3. Man ............................................................................................................................................................... 91
A. Testosteron .............................................................................................................................................. 91
B. Spermatogenese ....................................................................................................................................... 92
C. Afvoer ....................................................................................................................................................... 93
Transport .................................................................................................................................................. 93
Erectie ...................................................................................................................................................... 94
Ejaculatie .................................................................................................................................................. 96
Nier:
- Boonvormig orgaan
- Macroscopisch:
o Nierkapsel rond nier
o Medulla centraal in de nieren
o Cortex perifeer
- Nefronen: 1 miljoen/nier à ontstaan in cortex
o Nierlichaampjes: allemaal in cortex
§ Glomerulaire capillairen: een netwerk van capillairen
§ Kapsel van Bowman
• Parietaal blad langs buitenkant
• Visceraal blad dat capillairen omvat
§ Ruimte van Bowman binnenin kapsel
o Proximale tubulus
o Lis van Henle: keert terug naar nierlichaampje
o Macula densa: langs kant van nierlichaampje
à maakt contact met nierlichaampjes
à deel van lis van Henle
o Distale tubulus
o Verzamelbuis
- Bloedvaten van de nier:
o A. Renalis (zijtak van de aorta): splitst zich in heel veel ongenoemde takken
o Vele bloedvaten lopen uit in afferente arteriolen: kleine slagadertjes die bloed naar
glomerulaire capillairen aanvoeren
à afferente arteriolen lopen uit in glomerulaire capillairen
Normaal lopen capillairen uit in venen maar hier gebeurt dat niet. Capillairen lopen terug uit in
arteriolen (efferent). De arteriolen voeren bloed weg vanuit de glomerulaire capillairen naar de
peritubulaire capillairen (rond tubuli).
Peritubulaire capillairen monden uit in venen en al die venen komen terecht in v. Renalis en die gaat
draineren in v. Cava Inferior.
à peritubulaire capillairen – venen – v. Renalis – v. Cava Inferior
DUS:
Het bloed stroomt via de a. Renalis, zijn zijtakken en afferente arteriolen naar de glomerullaire
capillairen. Via efferente arteriolen komt het bloed in peritubulaire capillairen. De venen draineren in
de v. Renalis.
5
, B. Detectie van het extracellulair volume
Extracellulair volume:
- Volume van het extracellulair vocht (vocht van buiten cellen)
- 2 compartimenten:
o ¼ plasma in bloedvaten
o ¾ interstitium buiten bloedvaten
Volume arterieel plasma dat weefsels bevloeit (1/5) = effectief circulerend volume (ECV)
Wij kunnen onmogelijk extracellulair volume detecteren, we hebben geen sensoren voor detectie.
Ons lichaam kan wel het volume arterieel plasma dat de weefsels bevloeit (ECV) detecteren.
EVC vermenigvuldigen met 20 à zo heeft lichaam idee over extracellulair volume
ECV detecteren door: 3 parameters
- Arteriële druk meten: druk in slagaders (= bloeddruk)
à ECV
~ volume veneus plasma dat terugkeert naar hart
~ hartdebiet (hoeveelheid dat hart pompt)
~ arteriële druk
- Vulling:
à ECV
~ volume veneus plasma dat weefsels verlaat
~ vulling van hart en grote bloedvaten
- Aanvoer van NaCl naar de nier:
à ECV
~ aanvoer van NaCl naar de nier
6
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