III.

ANATOMY AND PHYSIOLOGY

PREGNANCY INDUCED HYPERTENSION ECLAMPSIA Cause: Unknown

KIDNEY

The kidneys are organs that serve several essential regulatory roles in most animals, including vertebrates and some invertebrates. They are essential in the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acidbase balance, and regulation of blood pressure (via maintaining salt and water balance). They serve the body as a natural filter of the blood, and remove wastes which are diverted to the urinary bladder. In producing urine, the kidneys excrete wastes such as urea and ammonium, and they are also responsible for the reabsorption of water, glucose, and amino acids. The kidneys also produce hormones including calcitriol, erythropoietin, and the enzyme renin.

Located at the rear of the abdominal cavity in the retroperitoneum, the kidneys receive blood from the paired renal arteries, and drain into the paired renal veins. Each kidney excretes urine into a ureter, itself a paired structure that empties into the urinary bladder. Renal physiology is the study of kidney function, while nephrology is the medical specialty concerned with kidney diseases. Diseases of the kidney are diverse, but individuals with kidney disease frequently display characteristic clinical features. Common clinical conditions involving the kidney include the nephritic and nephrotic syndromes, renal cysts, acute kidney injury, chronic kidney disease, urinary tract infection, nephrolithiasis, and urinary tract obstruction. Various cancers of the kidney exist; the most common adult renal cancer isrenal cell carcinoma. Cancers, cysts, and some other renal conditions can be managed with removal of the kidney, or nephrectomy. When renal function, measured by glomerular filtration rate, is persistently poor, dialysis and kidney transplantation may be treatment options. Although they are not severely harmful, kidney stones can be a pain and a nuisance. The removal of kidney stones includes sound wave treatment to break up the stones into smaller pieces, which are then passed through the urinary tract. One common symptom of kidney stones is a sharp pain in the medial/lateral segments of the lower back.

HYPOTHALAMUS

The hypothalamus is a portion of the brain that contains a number of small nuclei with a variety of functions. One of the most important functions of the hypothalamus is to link the nervous system to the endocrine system via the pituitary gland (hypophysis). The hypothalamus is located below the thalamus, just above the brain stem. In the terminology of neuroanatomy, it forms the ventral part of the diencephalon. All vertebrate brains contain a hypothalamus. In humans, it is roughly the size of an almond. The hypothalamus is responsible for certain metabolic processes and other activities of the autonomic nervous system. It synthesizes and secretes certain neurohormones, often called hypothalamic-releasing hormones, and these in turn stimulate or inhibit the secretion of pituitary hormones. The hypothalamus controls body temperature, hunger, thirst, fatigue, sleep, and circadian cycles.

PITUITARY GLAND

In vertebrate anatomy the pituitary gland, or hypophysis, is an endocrine gland about the size of a pea and weighing 0.5 g (0.02 oz.) in humans. It is a protrusion off the bottom of the hypothalamus at the base of the brain, and rests in a small, bony cavity (sella turcica) covered by a dural fold (diaphragma sellae). The pituitary is functionally connected to the hypothalamus by the median eminence via a small tube called the infundibular stem (Pituitary stalk). The pituitary fossa, in which the pituitary gland sits, is situated in the sphenoid bone in the middle cranial fossa at the base of the brain. The pituitary gland secretes nine hormones that regulate homeostasis.

ADRENAL GLANDS In mammals, the adrenal glands (also known as suprarenal glands) are endocrine glands that sit atop the kidneys; in humans, the right suprarenal gland is triangular shaped, while the left suprarenal gland is semilunar shaped. They are chiefly responsible for releasing hormones in response to stress through the synthesis of corticosteroids such as cortisol and catecholamines such as epinephrine. The adrenal glands affect kidney function through the secretion of aldosterone, a hormone involved in regulating the osmolarity of blood plasma. Anatomically, the adrenal glands are located in the retroperitoneum superior to the kidneys, bilaterally. They are surrounded by an adipose capsule and renal fascia. In humans, the adrenal glands are found at the level of the 12th thoracic vertebra. Each adrenal gland has two distinct structures, the outer adrenal cortex and the inner medulla, both of which produce hormones. The cortex mainly produces cortisol, aldosterone and androgens, while the medulla chiefly produces epinephrine and norepinephrine. The combined weight of the adrenal glands in an adult human ranges from 7 to 10 grams.

KIDNEY- Organs essential in the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid-base balance and regulation of blood pressure. SECRETES RENIN- Potent vasoconstrictor, thus it regulates the bodys mean art erial blood pressure. ACTIVATES RENIN-ANGIOTENSIN SYSTEM

ANGIOTENSIN I CONVERTED BY ANGIOTENSIN CONVERTING ENZYME (ACE)

ANGIOTENSIN II- Constricts blood vessels, increase the secretion of ADH and aldosterone

ALDOSTERONE- Increases reabsorption of ions and water in the kidney ADH- responsible for increasing water absorption in the collecting ducts of the kidney nephron

PERIPHERAL/VASCULAR VASOSPASM- Sudden narrowing of an artery in the arms or leg CAUSES: Decrease in O2 Decrease blood flow in the lower extremities Increase peripheral resistance in the upper extremities Increase blood pressure

IV. PATIENT AND HIS ILLNESS A. PATHOPHYSIOLOGY

ECLAMPSIA is the increase in blood pressure of greater than 160/110 mmHg with the presence of unexplained tonic-clonic seizure. CHIEF COMPLAINT: Seizure

DUE TO VASOCONSTRICTION KIDNEY

GFR DEGENERATION

Na REABSORPTION PERMEABILITY WATER RETENTION

PROTEIN (PROTEINURIA)

EDEMA

FLUID SHIFTING

BRAIN

EYES

CONGESTION

RETINOPATHY

CEREBRAL IRRITABILITY

O2 SUPPLY

SCOTOMA ELECTRICAL DISTURBANCES (SEVERE HEADACHE) OVER STIMULATION OF SUPERIOR EYE MUSCLE

CONVULSION/SEIZURE

ROLLING OF THE EYEBALL

CONVULSION/SEIZURE

B. SURGICAL MANAGEMENT

BRIEF DESCRIPTION

A Cesarean section delivery is done when it is not possible or safe for the mother to deliver the baby through the vagina. The procedure is usually done while the woman is awake. The body is numbed from the chest to the feet using epidural or spinal anesthesia. The surgeon makes a cut across the belly just above the pubic area. The womb (uterus) and amniotic sac are opened, and the baby is delivered. The health care team clears the baby's mouth and nose of fluids, and the umbilical cord is cut. The pediatrician or nurse makes sure that the infant's breathing is normal and that the baby is stable. The mother is awake, and she can hear and see her baby. The father or another support person is often able to be with the mother during the delivery.