Текст книги "Английский язык для медиков"

Автор книги: Елена Беликова

сообщить о нарушении

Текущая страница: 7 (всего у книги 8 страниц)

47. The urinary system: embriogenesis

The urinary system is formed mainly from mesodermal and endodermal derivatives. Three separate systems form sequentially. The pronephros is vestigial; the mesonephros may function transiently, but then mainly disappears; the metanephros develops into the definitive kidney. The permanent excre tory ducts are derived from the metanephric ducts, the uro—genital sinus, and surface ectoderm.

Pronephros: Segmented nephrotomes appear in the cervical intermediate mesoderm of the embryo in the fourth week. These structures grow laterally and canalize to form nephric tubules. Successive tubules grow caudally and unite to form the pronephric duct, which empties into the cloaca. The first tubules formed regress before the last ones are formed.

Mesonephros: In the fifth week, the mesonephros appears as «S—shaped» tubules in the intermediate meso—derm of the thoracic and lumbar regions of the embryo.

The medial end of each tubule enlarges to form a Bowman's capsule into which a tuft of capillaries, or glo—merulus, invaginates.

The lateral end of each tubule opens into the meson—ephrb (Wolffian) duct.

Mesonephric tubules function temporarily and degenerate by the beginning of the third month. The meson—ephric duct pesists in the male as the ductus epididymidis, ductus deferens, and the ejaculatory duct.

Metanephros: During the fifth week, the metanephros, or permanent kidney, develops from two sources: the ureteric bud, a diverticulum of the mesonephric duct, and the metan—ephric mas, from intermediate mesoderrn of the lumbar and sacral regions. The ureteric bud penetrates the metanephric mass, which cordenses around the diverticulum to form the metanephrogen cap. The bud dilates to form the renal pelvis. One—to—three million collecting tubules develop from the minor calyces, thus forming the renal pyramids. Penetration of collecting tubules into the metanephric mass induces cells of the tissue cap to form nephrons, or excretory units. The proximal nephron forms Bowman's capsule, wherea the distal nephron connects to a collecting tubule.

Lengtheningy of the excretory tubule gives rise to the proximal convoluted tubule, loop of Henle, and the distal convoluted tubule.

The kidneys develop in the pelvis but appear to «as—cend» into the abdomen as a result of fetal growth of the lumbar and sacral regions.

The upper and largest part of the urogenital sinus becomes the urinary bladder, which is initially continuous with the allantois. Later the lumen of the allantois becomes obliterated. The mucosa of the trigone of the bladder is formed by the incorporation of the caudal mesonephric ducts into the dorsal bladder wall. This mesodermal tissue is eventually replaced by endodermal epithelium so that the entire lining of the blad der is of endodermal origin. The smooth muscle of the bladder is derived from splanchnic mesoderm.

Mile urethra is anatomically divided into three portions: prostatic membranous, and spongy (penile).

The prostatic urethra, membranous urethra, and proximal penile urethra develop from the narrow portion of the uro genital sinus below the urinary bladder. The distal spongy urethra is derived from the ectodermal cells of the glans penis.

Fimale urethra: The upper two—thirds develops from the esonephric ducts, and the lower portion is derived from the ogenital sinus.

New words

urinary system – мочевая система

kidneys – почки

bladder – мочевой пузырь

excretory ducts – выделительные трубочки

pronephros – первичная почка

urogenital – мочеполовой

48. The urinary system: kidneys

The urinary system is the major system involved in the excre tion of metabolic waste products and excess water from the body. It is also important in maintaining a homeos—tatic bal ance of fluids and electrolytes. The urinary system consists of two kidneys, two ureters, the urinary bladder, and the ure thra. Urine is produced by the kidneys and is then transmit ted via the ureters to the bladder for temporary storage. The urethra is the final pathway that conveys urine to the exteri or. This system also has an important endocrine function in the production of renin and erythropoietin, which influence blood pressure and red blood cell (RBC) formation, respec tively.

Each kidney is composed of stroma and parenchyma. The stroma consists of a tough fibrous connective tissue capsule and a delicate interstitial connective tissue com posed of fibroblasts, wandering cells, collagen fibrils, and a hydrated proteoglycan extracellular matrix, which is col—lec tively called the renal interstitium. The parenchyma consists of more than one million elaborate uriniferous tubules that represent the functional units of the kidney.

The kidney contains a hilum, a cortex, and a medula. The hilum is located medially and serves entrance as the point of entrance and exit for the renal artery, renal veins, and ureter. The renal pelvis, the expanded upper, divides into two or three entrance into the kidney. These, in turn, divide into eight minor calyces.

The cortex forms the outer zone of the kidney.

The medulla appears as a series of medullary pyramids. Two or three pyramids may unite to form a papilla. Urinife—rous tubules consist of two functionally related portions called the nephron and the collecting tubule.

Glomerulus is made up of several anastomotic capillary loops interposed between an afferent and an efferent ar—teriole. Plasma filtration occurs in the glomerulus.

Bowman's capsule consists of an inner visceral layer and an outer parietal layer. The space between these layers, the uri nary space, is continuous with the renal tubule.

Visceral layer is apposed to the glomerulus and closely fol lows the branches of the glomerular capillaries. The visceral layer is composed of a single layer of epithelial cells resting on a basal lamina, which is fused with the basal lamina of the capillary endothelium. The cells of the visceral layer, call podocytes.

Cytoplasmic extensions of podocytes rest on the basal lamina.

Between adjacent pedicles, a thin slit diaphragm assists in preventing large plasma proteins from escaping from the vascular system.

In fact, most of the components of the glomerular filtrate are reabsorbed in the proximal tubule. Loop of Henle is ahairpin loop of the nephron that extends into the medulla and consists of thick and thin segments. The thick proximal portion of Henle's loop, or the descend ing thick segment, is a direct medullary continuation of the cortical proximal convoluted tubule.

The thick distal portion of the loop of Henle, the ascending thick segment, ascends to the cortex and is continuous with distal convoluted tubule. The major function of the distal tubule is to reabsorb soduim and chloride from the tubular filtrate. Collecting tubules consist of arched and straight segments.

New words

urea – моча

stroma – строма

parenchyma – паренхима

fibrous capsule – волокнистая капсула

delicate – тонкий

interstitial – промежуточный

49. The urinary system: kidney vascular sypply

Vascular supply begins with the renal artery, enters the kidney the hilum, and immediately divides into interlobar arteries. The arteries supply the pelvis and capsule before passing direct between the medullary pyramids to the corticomedullary junction. The interlobar arteries bend almost 90 degrees to form shoarching, arcuate arteries, which run along the corticomedullary junction. The arcuate arteries subdivide into numerous fine interlobul arteries, which ascend perpendicularly to the arcuate arteries through the cortical labyrinths to the surface of the kidney. Each interlobular artery passes midway between two adjacent medullary rays.

The interlobular arteries then give off branches that become the afferent arterioles of the glomeruli.

As the afferent arteriole approaches the glomerulus, some its smooth muscle cells are replaced by myoepithelio—id cells, which are part of the juxtaglomerular apparatus. The juxtaglomerular apparatus consists of juxtaglomeru—lar cells, polkissen cells, and the macula densa.

Cells of the distal convoluted tubule near the afferent arteriole are taller and more slender than elsewhere in the distal tubule.

The juxtaglomerular cells secrete an enzyme called re—nin, which enters the bloodstream and converts the circulating polypeptide angiotensinogen into angiotensin I. An—giotensin I is converted to angiotensin II, a potent vaso constrictor that stimulates aldosterone secretion from the adrenal cortex. Aldosterone increases sodium and water reabsorption in the distal portion of the nephron.

Their nuclei are packed closely, so the region appear darker under the light microscope. The macula densa is thought to sense sodium concentration in the tubular fluid.

Polkissen cells are located between the afferent and ef—fer ent arterioles at the vascular pole of the glomerulus, adja cent to the macula densa.

Their function is unknown. Efferent glomerular arteriole divides into a second system of capillaries, the peritub—ufar plexus, which forms a dense net work of blood vessels around the tubules of the cortex.

Arterial supply of the medulla is provided by the efferent arte rioles of the glomeruli near the medulla. The arterio—lae rectae and the corresponding venae rectae with their respective capillary networks comprise the vasa recta, which supplies the medulla. The endothelium of the venae rectae is fenestrated and plays an important role in maintaining the osmotic gradi ent required for concentrating urine in the kidney tubules.

New words

renal artery – почечная артерия

renal veins – почечные вены

expanded upper – расширенный верхний

minor calyces – незначительные чашечки

to supply – снабжать

arcuate arteries – дугообразные артерии

to subdivide – подразделять

numerous – многочисленный

interlobul – междолевой

to ascend – поднимать

perpendicularly – перпендикулярно

arcuate arteries – дугообразные артерии

50. The urinary system: ureters, uretra

The calyces, renal pelves, and ureters constitute the main excretory ducts of the kidneys. The walls of these structures, in particular the renal pelvis and ureter, consist of three coats: an inner mucosa, middle muscularis, and an outer adventitia.

Mucosa of the calyces and ureter is lined by a transitional epithelium, which varies in thickness with the distention of the ureter. In the collapsed state, the cells are cuboidal with larger с shaped cells in the superficial layer. In the relaxed state, the lumen of the ureter is thrown into folds that generally disappear when the organ dilates during urine transport. Muscularis consists of an inner longitudinal and an outer circular layer of smooth muscle. In the distal ureter, an additional discontinuous outer longitudinal layer is present.

Adventitia consists of loose connective tissue with many large blood vessels. It blends with the connective tissue of the surrounding structures and anchors the ureter to the renal pelvis. The urinary bladder functions as a strong organ for urine. The structure of the wall of the bladder is similar to but thicker than of the ureter. Mucosa of the urinary bladder is usually folded, depending the degree of the bladder distention. The epithelium is transitional and the number of apparent layers depends on the fullness of the bladder. As the organ becomes distended, the superficial epithelial layer and the mucosa become flattened, and the entire epithelium becomes thinner. At its fullest distention, the bladder epithelium maybe only two or three cells thick. Lamina propria consists of connective tissue with abundant elastic fibers. Muscularis consists of prominent and thick bundles of smooth muscle that are loosely organized into three layers. Adventitia covers the bladder except on its superior part, where serosa is present. Male urethra serves as an excretory duct for both urine and semen. It is approximately 20 cm in length and has three anatom ic divisions. The prostatic portion is lined by transitional epithelium similar to that of the bladder. The prostatic urethra is surrounded by the fibromuscular tissue of the prostate, which normally keeps the urethral lumen closed. In the membranous and penile portions, the epithelium is pseudostratified up to the glans. At this point, it becomes stratified squamous and is continuous with the epidermis of the external part of the penis. The membranous urethra is encircled by a sphincter of skeletal muscle fibers from the deep transverse perineal muscle of the urogenital diaphragm, which also keeps the urethral lumen closed. The wall of the penile urethra contains little muscle but is surrounded and supported by the cylindrical erectile mass of corpus spongiosum tissue. Female urethra is considerably shorter than that of the male urethra. It serves as the terminal urinary passage, conducting urine from the bladder to the vestibule of the vulva. The epithelium begins at the bladder as a transitional variety and becomes stratified squamous with small areas of a pseudostratified columnar epithelium. The muscularis is rather indefinite but does contain both circu lar and longitudinal smooth muscle fibers. A urethral sphincter is formed by skeletal muscle as the female urethra passes through the urogenital diaphragm.

New words

ureter – мочеточник

renal pelvis – почечная лоханка

calyces – чашечки

urethra – уретра

51. The kidney's function

The kidneys are filters which remove waste products from the blood. In the human each is a bean—shaped organ, some four inches long and about two inches wide. The two are situated high up on the posterior abdominal wall behind the peritoneum and in front of the lats ribs and the upper two lunbar transverse processes. Each is invested by a fibrous capsule surrounded by more or less peri—nephric fat. On the upper pole of each is a supra—renal gland. On the medical side is a notch called the hilum where the vessels and the ureter are attached.

Vertical selections through a kidney discloses three more or less concentric zones. The other light—colored zone is the renal cortex, within this is the darker renal medulla and within this again is a space – the renal sinus which is normally occurred by a fibrous bag called the renal pelvis. The pelvis opens below into the ureter. The cortex extends inwards in a series of renal columns which divide the medulla into a number of renal pyramids. Each pyramid has a free rounded projection – a renal papilla – which lies in a cap – like extension, of the pelvis cal led a renal calyx. The pelvis is lined by transitioual epithelium, which extends the calyces and covers the papillae.

Within the cortex each minute artery presents along its course a convoluted knot, called a glomerulus; the branch which enters the knot is the afferent vessel, that which leaves is she efferent vessel. Each glomerulus project into the dilated end of its corresponding renal tubule, from which it is separated by a thin layer of cells called glome—rular (Bowman' s) capsule; glomerulus plus capsule form a renal (Nalpighian) corpuscle. The cortex contains multitudes of such corpuscles, each giving rise to a tubule which passes down into the medul la and back again in the so—called loop of Henle. Back in, the cortex loop ends in a functional tubule which joins а larger collecting tube. Ultimately, a number of collecting tubes combine to form an excretory tube, which opens at the ареx of a papilla into a renal calyx. The efferent vessel from the glomerulus accompanies the loop of Henle, supply ing the tubule on the way and finally ends in a small vein. A renal corpuscule plus its complement of tubules and blood vessels is called a renal unit, or nephron; there are said to be one million such units in each kidney, their tubing totaling a length of some twenty miles.

New words

bean—shaped organ – орган в форме боба

four inches long – 4 дюйма в длину

two inches wide – 2 дюйма в ширину

peritoneum – брюшина

lumbar – поясничный

renal cortex – корковый слой

renal medulla – мозговой слой

fibrous – волокнистая

dilated – расширенный

to be separated – быть разделенным

loop of henle – петля Генле

52. Acute renal failure

The two major mechanisms may participate in association between intratubular hemorrage and nephron damage in acute renal failure. The first mechanism is direct nephrotoxicity from hemoglobin, because intratubular degradation of erythrocytes releases heme and iron which are toxic to cells. The second mechanism is hypoxic damage induced by regional vasoconstriction because heme avidly binds the potent vasodilator nitric oxide.

Intratubular degradation of hemoglobin releases heme containing molecules and eventually free iron. These breakdown products, also elaborated from myoglobin, probably play an important role in the pathogenesis of acute tubular necrosis. Endocytic reabsorption from the tubular him en of filtered free hemoglobin or myoglobin may be a major pathway to proximal tubular damage in pigment nephropathy. In addition, free iron promotes the formation of oxygen free radicals, lipid peroxidation and cell death Another source of toxic iron is from the breakdown of intracellular cytochrom P–450 under hypoxic condition. One of the most potent intrarenal vasodilator system is nitric oxide, produced from L—arginine in vascular endothelium. smooth muscle and tubular calls, causing Vascular smooth muscle relaxation through the induction of intracellular cyclic GMP. Blocking nitric oxide synthesis causes profound vascular constriction, systemic hypertension and a marked decline in renal blood flow. Endothelial dysfunction with reduced nitric oxid production may underlie the defective regional vasodilation in diabetes and atherosclerosis, predisposing to renal ischemia and nephrotoxic insult.

Hemoglobin avidly binds nitric oxide and ingibits nitrovasodilation. The presence of large pool of hemoglo bin in the tubular lumen could therefore affect the vasomotor balance of kidney circulation: intrarenal vasoconstriction is likely to be most pronounced and most significant in the medulla., because the ratio of tubular mass to vessels surface may be particularly high in this region. The medulla normally functions at low oxygen tension, because of limited medulla blood flow and counter—current exchange of oxygen. Inhibinion of nitric oxide synthesis induces severe and prolonged outer medullary hypoxia and predisposes to tubular necrosis Unfortunately, biopsy specimens of glomerulonephritis associated with acute tubular necrosis do not provide the precise distribution of the tubular lesions.

In chronic glomerulonephritis tubulo—interstitiaJ damage has often been reported as correlate of kidney function and also its best prognostic marker. Glomerular obsolescence deprives the renal parenchyma from nutritional blood flow, leading to tubule—interstitial fibrosis in medullary rays and outer medulla. Proteinuria imposes to the proximal tubules a constant burden of reabsorption and catabolism of albumin and other proteins from the tubular lumen, which have been suggested to cause cellular injury.

New words

nephron – нефрон

intratubular – внутриканальцевый

heme – гем

tubular necrosis – канапьцевый некроз

reabsorption – реабсорбция

proteinuria – протеннурия

53. Iron in the body

It is accepted that the total amount of iron in the body is between 2 and 5 g., varying with body—weight and hemoglobin level; about two—thirds of this is in the form of hemoglobin and about 30 % is storage iron; iron in 1 т1уо– globin and enzymes makes up the small remaining fraction together with iron in transport, which is only 0,12 %. There is a big difference between the sexes: in the adult male the total iron is about 50 mg. per kg. body—weight. But in the adult female the figure is only 35 mg. per kg., mainly be cause the normal blood—level of hemoglobin is lower than in the male. Iron exists in the body mainly in two forms: firstly, as heme in hemoglobin, and cytochrome concerned with the utilization of oxygen; and secondly, bound to a protein without heme formation, as storage and transport iron. Iron in the body has a very rapid turnover, since some 3 million red blood cells are broken down per second and the greater part of the iron released is returned to the bone marrow and re—formed into fresh hemoglobin; some 6,3 g. of hemoglobin containing 21 mg. of iron is handled this way every 24 hours.

The amount of iron in the body is regulated by control of absorption, since excretion is very small. The amount of iron absorbed from food differs with different foodstuffs, so the com position of the diet is important. Absorption can be increased in the normal Individual when the blood—hemoglobin is lower than normal and is the iron stores are low. Iron stores are normally lower in women than men and so they tend to absorb more iron. Iron absorption can decrease in older persons, especially in those over 60. Many estimates have agreed that the average Western diet pro vides between 10 and 15 mg. of iron daily, of which only 5—10 % is absorbed.

Iron absorption takes place mainly in the upper jejunum, though some is absorbed in all parts of the small intestine and even in the colon. Iron in food is mostly in ferric form and must b е reduced to the ferrous form before it can be absorbed; this reduction begins in the stomach – though very little is absorbed there – and continues in the small intestine. The iron is absorbed via the brush—border of the intestine and then may take one of two paths; it is either passed into the blood, where it combines with a globulin, and passes to the marrow or to storage sites; or it combines with the protein, which is then deposited in the intes tinal cells.

Iron is lost mostly through the gastrointestinal tract by way of red cells and intestinal cells containing iron lost in the constant desquamation from the intestinal mucosa.

New words

iron – железо

varying – изменение

hemoglobin – гемоглобин

storage – хранение

mioglobin – миоглобин

fraction – фракция

together – вместе

body—weight – масса тела

desquamation – десквамация