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Samenvatting 1.3 Regulatie en Integratie (GEN1103)
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Alle uitgewerkte casussen en collega's die horen bij het blok 1.3 regulatie en integratie (GEN1103).
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Blok 1.3Regulatie en integratie
,Inhoudsopgave
Casus 1 ........................................................................................................................................................... 5
Homeostase ........................................................................................................................................................ 5
Negatieve feedback ....................................................................................................................................... 5
Positieve feedback ......................................................................................................................................... 6
De ‘winst’ van een controlesysteem .............................................................................................................. 6
Anatomie, histologie en fysiologie van de bijnieren ........................................................................................... 6
Bloedtoevoer ................................................................................................................................................. 8
Bloedafvoer.................................................................................................................................................... 8
Fysiologie ....................................................................................................................................................... 9
Histologie ....................................................................................................................................................... 9
Wat is de anatomie van de hypothalamus, hypofyse en epifyse? .................................................................... 10
De hypothalamus ......................................................................................................................................... 10
De hypofyse ................................................................................................................................................. 11
Hormonen van de hypothalamus en hypofyse ............................................................................................ 14
De epifyse (pijnappelklier) ........................................................................................................................... 14
De HPA-as en stress response ........................................................................................................................... 15
Anatomie en fysiologie van de HPA-as ........................................................................................................ 15
Hoe helpt cortisol tijdens stress?................................................................................................................. 17
Wanneer wordt de HPA-as geactiveerd? ..................................................................................................... 17
.......................................................................................................................................................................... 19
De biologische klok ........................................................................................................................................... 20
Overdag ....................................................................................................................................................... 20
S’nachts ........................................................................................................................................................ 20
Clock genen.................................................................................................................................................. 20
Artikel ............................................................................................................................................................... 22
Casus 2 ......................................................................................................................................................... 23
Anatomie, functie & histologie van de blaas .................................................................................................... 23
Functie ......................................................................................................................................................... 23
Vorm ............................................................................................................................................................ 23
Spieren ......................................................................................................................................................... 24
Vascularisatie ............................................................................................................................................... 25
Histologie ..................................................................................................................................................... 27
Anatomie, functie & histologie van de nieren................................................................................................... 27
Ligging .......................................................................................................................................................... 27
De verschillende lagen ................................................................................................................................. 28
Vascularisatie ............................................................................................................................................... 29
Onderdelen van de nier ............................................................................................................................... 30
Nefronen ...................................................................................................................................................... 31
Het JGA ........................................................................................................................................................ 33
Fysiologie van de nieren ................................................................................................................................... 34
Glomerulaire filtratie ................................................................................................................................... 34
De autoregulatie van GFR en renale perfusie ................................................................................................... 37
Intrinsiek ...................................................................................................................................................... 37
Extrinsiek (bij lage bloeddruk) ..................................................................................................................... 38
De mictie ........................................................................................................................................................... 39
College: fluid homeostasis theory ................................................................................................................. 41
, Belangrijke begrippen .................................................................................................................................. 41
Diffusie ......................................................................................................................................................... 42
Osmose ........................................................................................................................................................ 42
Lymfe ........................................................................................................................................................... 44
Oedeem ....................................................................................................................................................... 45
College: fluid homeostasis practice ............................................................................................................... 46
Toevoegen van slechts een zout ....................................................................................................................... 47
Toevoegen van water ....................................................................................................................................... 48
Toevoegen van water met een opgelost zout ................................................................................................... 48
Homeostasis of osmolality ................................................................................................................................ 48
Casus 3 ......................................................................................................................................................... 50
Tubulaire reabsorptie en secretie van de nieren............................................................................................... 50
De proximaal ingewikkelde buis .................................................................................................................. 50
De lus van Henle .......................................................................................................................................... 53
De distaal ingewikkelde buis ........................................................................................................................ 54
Het verzamelkanaal ..................................................................................................................................... 56
Regulatie van de osmolaliteit van het bloed..................................................................................................... 58
Osmolaliteit en Osmolariteit........................................................................................................................ 58
Osmotische waarden lichaamsvloeistoffen ................................................................................................. 58
ADH .............................................................................................................................................................. 58
Dehydratatie ................................................................................................................................................ 59
Werking van het RAAS-systeem ........................................................................................................................ 60
Counter current mechanismen ......................................................................................................................... 62
Counter current multiplier ........................................................................................................................... 62
Counter current exchanger .......................................................................................................................... 62
Normaalwaardes urine ................................................................................................................................ 63
Casus 4 ......................................................................................................................................................... 64
Renale klaring ................................................................................................................................................... 64
Inulineklaring kan gebruikt worden voor een nauwkeurige schatting van GFR .......................................... 65
Clearance ratio ............................................................................................................................................. 65
Farmacokinetiek (basics) .................................................................................................................................. 66
Absorptie ..................................................................................................................................................... 66
Distributie .................................................................................................................................................... 67
Eliminatie ..................................................................................................................................................... 68
..................................................................................................................................................................... 68
Metabolisme ................................................................................................................................................ 69
Halfwaardetijd ............................................................................................................................................. 69
Het meten van nierfunctie ................................................................................................................................ 72
Waarom is het belangrijk om nierfunctie te meten? ................................................................................... 72
Urineonderzoek ........................................................................................................................................... 72
Ureum gehalte ............................................................................................................................................. 72
Fosfor gehalte .............................................................................................................................................. 72
Eiwitgehalte ................................................................................................................................................. 72
Creatinine gehalte........................................................................................................................................ 72
Creatinine klaring ......................................................................................................................................... 74
MDRD (modifications of diet renal disease equation) & CKD-EPI................................................................ 74
Inuline klaring .............................................................................................................................................. 75
Andere tests ................................................................................................................................................. 75
, Plasmaconcentratiecurve ................................................................................................................................. 76
AUC .............................................................................................................................................................. 76
Verband tussen halfwaardetijd en het verdelingsvolume ................................................................................ 76
PAH-klaring kan gebruikt worden om GFR te schatten .................................................................................... 77
College: Farmacokinetiek.............................................................................................................................. 79
Plasmaconcentratiecurve ................................................................................................................................. 79
Manieren van toedienen................................................................................................................................... 81
Voorbeelden ..................................................................................................................................................... 81
Bepalen van Co ................................................................................................................................................. 85
Casus 5 ......................................................................................................................................................... 88
Accuut nierfalen ................................................................................................................................................ 88
Prerenale oorzaken van accuut nierfalen .................................................................................................... 88
Intrarenale oorzaken van accuut nierfalen .................................................................................................. 91
Postrenale oorzaken van accuut nierfalen .................................................................................................. 92
Pathofysiologie ............................................................................................................................................ 93
Gevolgen ...................................................................................................................................................... 95
Hypovolemische shock ...................................................................................................................................... 95
Oorzaak ........................................................................................................................................................ 95
Gevolg .......................................................................................................................................................... 96
Hyperkaliëmie ................................................................................................................................................... 96
Oorzaken van hyperkaliëmie ....................................................................................................................... 97
Gevolgen ...................................................................................................................................................... 98
Acute tubulusnecrose ....................................................................................................................................... 98
Oorzaken ...................................................................................................................................................... 99
Bevindingen bij urineonderzoek .................................................................................................................. 99
Behandeling ................................................................................................................................................. 99
Geprogrammeerde celdood .............................................................................................................................. 99
Apoptose & necrose .................................................................................................................................... 99
Symposium imaging techniques.................................................................................................................. 101
Casus 6 ....................................................................................................................................................... 103
Oedeem .......................................................................................................................................................... 103
Druk in arterieel gedeelte capillair ............................................................................................................ 103
Druk in veneus gedeelte capillair ............................................................................................................... 103
Soorten oedeem ........................................................................................................................................ 104
Welke factoren hebben hier invloed op? .................................................................................................. 104
Oorzaken oedeem...................................................................................................................................... 104
Anatomie en functie van het lymfestelsel ................................................................................................. 106
College: cell death ...................................................................................................................................... 107
Apoptose ......................................................................................................................................................... 107
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