By this process, products (e.g urea) but not the electrolytes are taken out of the blood of the patient

physiological principle is given below: Dialysis is done in renal failure (acuie or chronic) cases. By this process, products (e.g urea) but not the electrolytes are taken out of the blood of the patient, so that afler this treatment Blood maybe said to have beer cleansed In peritoneal deiysJs, a physiologic af fluid, eotonrc. with blood, is ntroduced into me peritoneum This physiologic flud, although contaning the electrolytes, is free of waste product (urea, unc acti etc). The physiologic fluid, called dialysate, stays for about \i2 hr and urea, uric acid etc. diffuse out forn the blood to enter the dialysate. me peritoneal membrane acting as me dalysis membrane. Now, the diatysate is removed. The process can be repeated many times. in hemodofosis, the bood from an artery is led into an "artificial kidney. where me bood remains separated from me diarysate try a celiophane wall, and the waste products leave the bood to enter the diaiysale. The blood is now returned from me artificial kidney to a vein of the patent other types or arrangements also exist. Dialysis has remarkably (hanged me outlook of cases of renal failure. Now. many cases of chrome renal failure lead a reasonably normal life, by undergoing diarysis at regular intervals (say several times a month), although these palients must remain, psychologically speaking, tod up with the dialyslng machine DIURETICS Durellcs are drugs/agents, that can cause Increase in urinary output. Diuretics thus reduce ECF and thus lower the BP, removes edema and are life saving agents in acute left ventricular failure Recall, in the Starling's law of heart (sec V chap 2), when the law operates in the descending imb (fig.5.2.2), a vrcious cycle is developed which crust be interrupted, otherwise the patient will die (see "heart failure' in chap. 12 sec V)This is done by acute and drastic reduction of ECF by the help of diuretics. Diuretics are also used in other conations lite taised intracramal pressure (cerebral edema) and so on Several classes of diuretics are known Mechanem of actions of some major types of mem. with a view to have greatennsght In physiology are hinted below. I. Osmotic diuretics. Mannitol the typical example This drug is given by IV transfusion finer ed by me Wflnevappears n me tubular fluid raises me osmotic tension of tubular flud hampers reateorption of water diuresis 2 Carbonic artiytirase rpA) inhibitors. The enzyme CA which is present pienirfuiry n the proximal convoluted tubule PCT, catarvzes the reaction. CA inhibitors, like acetazolamide (Diamox R), therefore stops me generation of H+ ions n the PCT cells (fig. 8.2.3) stoppage of H+ secretion and thus Na+ H+ exchange system fails, that is. stoppage of Na+of Na HC03 re absorption occurs loss of Na+via unne loss of excess water via urine.it is reminded that whenever there is Na loss from the body, there shall be a loss of water (In proportionate amount) from the body However, aceiazolamide can cause retention of h+ (acidosis). 3. Thiazides How exactly these powerful agents ad is not very clear. This much, however, is dear that they act on the earty part of distaf tubule, inhibiting bom Na+ and Cl- ions, so that flud reaching farther distal parts of the tubutes are not sufficiently dilute. 4. Loop duretics like furos«mide (Lasixs R) are etfremery popular, powerful, short acting agents that act on me toop of Henle (hence the name) Recall, some 25% of Na+ is reabsoroed from the ascending loop of Henle. Loop diuietjcs prevent the. reabsorptnn from the ascending Iimb of Henles loop, of both Na+ and Cl MICTURITION 1. Functional anatomy. 2. The mechartsm of rnctunuon, The micturition reflex, its path and center, higher control. Maintenance of continence.3. Applied physology:. (i) automatic bladder (i) retention (ii) effects of emotion (iv) bladder in pregnancy Functional anatomy of the urinary bladder The bladder is a hollow muscular organ, its interior being Ined with mucous membrane. The muscles of the bladder are smooth muscles. The two ureters(one from each kidney) enter the bladder Before they enter, they run through a short course wrthin the muscles of the otadde^. the causes a sort of a valve ike arrangement, so that retrograde movement of unne (that is from the Bladder to the ureter) e nomallY impossible. From the bottom part of the bladder, another tube, the urethra, arises. In case of males, it is long, and runs through the prostate (where it is called, prostatic urethra) and penis (where it is encased within corpus spongiosum) b open eitenorty [tig 6.9.1). The muscles of me body of the urinary bladder are called the detiusor muscles. The muscles round the urethra, at Its begnnng (that is. where ft commences from the bladder) is called the sphincter1 The mucous membrane of the bladder, excepting the part called tngone. is thrown into folds white tne bladder jsempfr Theimng epithelium (sometmes called urothelium) is transitonai epithetum and funtuonaly somewhat unusual .The urine in the bladder ts hyperlonic and rich in saltis. The blood within me cap'larles of the mucous membrane of the bladder rs only 12 rm away and yet the urothellim is so impervious that neither the solutes from unne go to the blood nor water of the caplary blood enters the bladder in accordance with the law of osmotaily. Teleologicaly. this highly desraUe, as otherwise the very purpose of the kidney would have been lost to a great extent. Bom the detrusor and the fntemalsphmcienc muscles are suppled by both the drnstons of the autonomic nerves, viz, the sympametic and the parasvmpametic nerves. nerve supply The urnary bladder recews bofi sympathetic and parasympametic suppry Both the sympathelic and parasympathate nerves contain afferent and efferent fibers Parasympathetic. The efferent tlbeis arise from the lateral homs of the 2nd and 3rd sacral segments of the spnal cord, run via the pelvic sptancnnc and relay m the hypogastric ganglion. The typogastnc ganglia are situated ventral to me sacrum (sacral promontory, to be precrse). The efferent fibers of the parasympalhelc suppry me detrusor and the muscles of me internal sphincter When stimulated they cause contraction of the detrusor and relaxation of me internal sphncter leading to evacuation of the bladder. The afferent fibers belongng to the parasvmpathetic system anses from me btadder pass in to the pelvic splanchnic and enters nto the dorsal root of the 2nd and 3rd sacral segments of Ihe spnal cord When the badder is suffloanlty distended, the bladder is stretched and thrs sensation of stretch is earned by these afferent paras^mpathetic nerves to Ihe spinal cord Sympathetic The efferent fibers arise from the