The Urinary System

1. 1. 2. 3. Match the terms 1-20 with their definitions a-t: 19. urinalysis bladder calculus calyx a. a yellowish liquid, containing water and waste products b. circular band of muscle which surrounds an opening or passage in the body c. either of two organs situated in the lower part of the back on either side of the spine whose function is to maintain the usual concentrations of the main constituents of blood, passing the waste matter into the urine d. group of blood vessels which filter waste matter from the blood in a kidney e. hard mass like a little piece of stone, which forms inside the body f. inability to control the discharge of urine or faeces g. inflammation of the urinary bladder, which makes someone pass water often and with a burning sensation h. involuntary passing of urine i. one of the two tubes which take urine from the kidneys to the urinary bladder j. opening leading to an internal passage in the body k. part of the body shaped like a cup especially the tube leading to a renal pyramid l. procedure in which a membrane is used as a filter to separate soluble waste substances from the blood m. the analysis of urine, to detect diseases n. the passing of urine out of the body o. the sac where the urine collects before being passed out of the body p. the strong basin-shaped ring of bone near the bottom of the spine, formed of the hip bones at the front and sides and the sacrum and coccyx at the back q. tiny structure in the kidney through which fluid is filtered r. triangular piece of the wall of the bladder, between the openings for the urethra and the 20. urine s. t. two ureters tube which takes urine from the bladder to be passed out of the body unusual presence of blood in the urine, as a result of injury or disease of the kidney or bladder

2.

For gaps 21-30 make a new word from the one in capitals:

4. 5. 6. 7. 8. 9.

cystitis dialysis enuresis glomerulus haematuria incontinence

10. kidney 11. meatus 12. micturition 13. nephron 14. pelvis 15. sphincter 16. trigone

The urinary system is also called the 21. ...... (EXCRETE) system because one of its main functions is 22. ...... (EXCRETE), removal and 23. ...... (ELIMINATE) of metabolic waste products from the blood. It has many other functions as well, including 24. ...... (REGULATE) of the volume, acid-base balance (pH), and electrolyte 25. ...... (compose) of body fluids. The kidneys lie against the back muscles in the upper abdomen at about the level of the last 26. ...... (THORAX) and first three lumbar vertebrae. The right kidney is 27. ...... (SLIGHT) lower than the left to accommodate the liver. Each kidney is firmly enclosed in a 28. ...... (MEMBRANE) renal capsule made of 29. ...... (FIBRE) connective tissue. In addition, there is a 30. ...... (PROTECT) layer of fat called the adipose capsule around the organ. An outermost layer of fascia anchors the kidney to the peritoneum and abdominal wall. The kidneys, as well as the ureters, lie posterior to the peritoneum. Thus, they are not in the peritoneal cavity but rather in an area known as the retroperitoneal space. 3. For gaps 31-40 choose the correct variant A, B or C:

17. ureter 18. urethra

Blood is brought to the kidney by a short 31. ...... of the abdominal aorta called the renal artery. After entering the kidney, the renal artery subdivides into smaller and smaller branches, which eventually make contact with the 32. ...... units of the kidney, the nephrons. Blood leaves the kidney by vessels that finally 33. ...... to form the renal vein, which carries blood into the inferior vena cava to return it to the heart. The kidney is a somewhat 34. ...... organ about 10 centimetres long, 5 centimetres wide and 2.5 centimetres thick. On the medial border there is a 35. ...... called the hilum, where the renal artery, the renal vein, and the ureter 36. ...... with the kidney. The lateral border is convex, giving the entire organ a bean-shaped appearance. The kidney is divided into two regions: the renal cortex and the renal medulla. The renal cortex is the kidneys outer 37. ...... . The renal medulla contains the tubes in which urine is formed and collected. These tubes form a number of coneshaped structures called renal pyramids. The tips of the pyramids 38. ...... toward the
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The Urinary System

renal pelvis, a funnel-shaped basin that forms the upper end of the ureter. Cuplike 39. ...... of the renal pelvis surround the tips of the pyramids and 40. ...... urine; these extensions are called calyces. The urine that collects in the pelvis then passes down the ureters to the bladder. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. A. A. A. A. A. A. A. A. A. A. stem functional amalgamate compressed notch fix portion indicate additions assemble B. B. B. B. B. B. B. B. B. B. branch useful integrate compacted scratch connect fraction show extensions collect C. C. C. C. C. C. C. C. C. C. limb serviceable merge flattened score hook share point wings save 5. For gaps 56-65 choose the correct ending A-J:

4.

Fill in gaps 41-55 with ONE word only:

The basic unit of the kidney, 41. ...... actually does its work, is the nephron. The nephron is essentially a tiny coiled tube with a bulb 42. ...... one end. This bulb, known 43. ...... the glomerular (Bowman) capsule, surrounds a cluster of capillaries called the glomerulus. Each kidney contains about 1 million nephrons. 44. ...... all these coiled tubes were separated, straightened out, and laid end to end, they 45. ...... span about 120 kilometres. A small blood vessel, the afferent arteriole, supplies the glomerulus 46. ...... blood; another small vessel, called the efferent arteriole, carries blood 47. ...... the glomerulus. When blood leaves the glomerulus, it does 48. ...... head immediately back toward the heart. Instead, 49. ...... flows into a capillary network that surrounds the tubular portion of the nephron. These peritubular capillaries are named for their location. The tubular portion of the nephron consists 50. ...... several parts. The coiled part leading from the glomerular capsule is called the proximal convoluted tubule. The tubule then uncoils 51. ...... form a hairpin-shaped segment called the loop of Henle. 52. ...... first part of the loop, which carries fluid toward the medulla, is the descending limb. The part that continues from the turn of the loop and carries fluid 53. ...... from the medulla, is the ascending limb. Continuing from the ascending limb, the tubule coils once again into the distal convoluted tubule. The distal end of each tubule empties 54. ...... a collecting duct, which then continues through the medulla toward the renal pelvis. The glomerulus, glomerular capsule, and the proximal and distal convoluted tubules of the nephron 55. ...... within the renal cortex. The loop of Henle and collecting duct extend into the medulla.

The first portion of the distal convoluted tubule curves back toward the glomerulus 56. ...... . At the point where the distal convoluted tubule makes contact with the afferent arteriole, there are specialised cells in each 57. ...... . This apparatus helps 58. ...... . When blood pressure falls too low for the kidneys to function effectively, cells in the wall of the afferent arteriole secrete the enzyme renin 59. ...... . Except for the excretion of unwanted substances, such as cellular metabolic waste, excess salts, and toxins the kidneys are also involved in the maintenance of water balance, regulation of the acid-base balance of body fluids, regulation of blood pressure and regulation of red blood cell production. One product of amino acid metabolism is nitrogen-containing waste material, a chief form of 60. ...... . After synthesis in the liver, urea is transported in the blood to the kidneys for elimination. The kidneys have a specialised mechanism for the elimination of urea and other nitrogenous wastes. Although the amount of water gained and lost in a day can vary tremendously, the kidneys can adapt 61. ...... . Acids are constantly produced by cellular metabolism. Certain foods can yield acids or bases, and people may also ingest antacids, such as bicarbonate. However, if the body is 62. ...... . The kidneys depend on blood pressure to filter the blood. If blood pressure falls too low for effective filtration, the cells of the juxtaglomerular apparatus release renin. This enzyme activates angiotensin, a blood protein that causes blood vessels to constrict, thus raising blood pressure. Angiotensin also stimulates the adrenal cortex to produce the hormone aldosterone, 63. ...... . When the kidneys do not get enough oxygen, they produce the hormone erythropoietin, 64. ...... . Erythropoietin made by genetic engineering is now available 65. ...... . A. to function normally, the pH of body fluids must remain in the range of 7.35 to 7.45 B. to pass between the afferent and efferent arterioles C. to regulate kidney function D. to these variations, so that the volume of body water remains remarkably stable from day to day E. to treat severe anaemia, such as occurs in the end stage of kidney failure F. which is urea G. which promotes retention of sodium and water, also raising blood pressure H. which raises blood pressure I. which stimulates the red cell production in the bone marrow J. which together make up the juxtaglomerular apparatus
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The Urinary System

6. Use the words in the box to fill in gaps 66-85: capillaries flow osmosis substances urine composition materials place system vitamins diameter nephron processes tissue walls filtrate nutrients reabsorption twists water 7. From the word given in capitals make a new one that fits in the gaps 86-95:

As fluid filtered from the blood travels slowly through the 66. ...... and turns of the nephron, there is ample time for exchanges to take 67. ...... . These processes together allow the kidney to filter body fluids as they adjust the 68. ...... of the urine. The process of urine formation begins with the glomerulus in the glomerular capsule. The walls of the glomerular capillaries are sieve-like and permit the free 69. ...... of water and soluble materials through them. Like other capillary 70. ...... , however, they are impermeable to blood cells and large protein molecules, and these components remain in the blood. Because the 71. ...... of the afferent arteriole is slightly larger than that of the efferent arteriole, blood can enter the glomerulus more easily than it can leave. Thus, blood pressure in the glomerulus is about three to four times higher than it is in other 72. ...... . As a result of increased fluid (hydrostatic) pressure in the glomerulus, 73. ...... are constantly being pushed out of the blood and into the glomerular capsule of the 74. ...... . The fluid that enters the glomerular capsule, called the glomerular filtrate, begins its journey along the tubular 75. ...... of the nephron. In addition to water and the normal soluble 76. ...... in the blood, other substances, such as 77. ...... and drugs, may also be filtered and become part of the glomerular filtrate. The kidneys form about 160 to 180 litres of 78. ...... per day. However, only 1 to 1.5 litres of urine are eliminated daily. Clearly, most of the 79. ...... that enters the nephron is not excreted with the 80. ...... , but rather, is returned to the circulation. In addition to water, many other substances the body needs, such as 81. ...... and ions, pass into the nephron as part of the filtrate, and these also must be returned. Therefore, the process of filtration that occurs in the glomerular capsule is followed by a process of tubular 82. ...... . As the filtrate travels through the tubular system of the nephron, water and other needed substances leave the tubule and enter the surrounding 83. ...... fluid, or interstitial fluid. They move by several 84. ...... including: diffusion (the movement of substances from an area of higher concentration to an area of lower concentration), 85. ...... (diffusion of water through a semipermeable membrane) and active transport (movement of materials through the plasma membrane). The substances that leave the nephron and enter the interstitial fluid then enter the peritubular capillaries and return to the circulation. In contrast, most of the urea and other nitrogenous waste materials are kept within the tubule to be eliminated with the urine.

Before the 86. ...... (FILTER) leaves the body as urine, the kidney makes final 87. ...... (ADJUST) in composition by the process of tubular secretion. In this process, some substances are 88. ...... (ACTIVE) moved from the blood into the nephron. Potassium ions are moved into the urine by this process. 89. ...... (IMPORTANT), the kidneys regulate the acid-base balance of body fluids by the active secretion of hydrogen ions. Some drugs, such as penicillin, are also actively secreted into the nephron for 90. ...... (ELIMINATE). The amount of water that is eliminated with the urine is regulated by a complex mechanism within the nephron that is influenced by antidiuretic hormone, a hormone released from the posterior pituitary gland. The process is called the countercurrent mechanism because it involves fluid travelling in 91. ...... (OPPOSE) directions within the ascending and descending limbs of Henles loop. As the filtrate passes through Henles loop, electrolytes, especially sodium, are actively pumped out by the cells of the nephron, resulting in an increased 92. ...... (CONCENTRATE) of the interstitial fluid. Because the ascending limb of Henles loop is not very permeable to water, the filtrate at this point becomes 93. ...... (INCREASE) dilute. As the filtrate then passes through the more permeable distal convoluted tubule and collecting duct, the concentrated fluids around the nephron draw water out to be returned to the blood. In this manner, the urine becomes more concentrated as it leaves the nephron and its volume is reduced. In other words, glomerular filtration allows all 94. ...... (DIFFUSE) materials to pass from the blood into the nephron, then tubular reabsorption moves useful substances back into the blood while keeping waste products in the nephron to be eliminated in the urine. After this stage the tubular secretion moves 95. ...... (ADD) substances from the blood into the nephron for elimination and the countercurrent mechanism concentrates the urine and reduces the volume excreted. 8. Combine the terms on the left 1-10 with those on the right a-j to form associations that fit in gaps 96-105: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. bladder connective digestive distal involuntary mucous parietal renal ureteral urinary a. b. c. d. e. f. g. h. i. j. bladder membrane muscle openings pelvis peritoneum portion system tissue wall
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The Urinary System

Each of the two ureters is a long, slender, muscular tube that extends from the kidney down to and through the inferior portion of the 96. ...... . The ureters, which are located posterior to the peritoneum and, at the 97. ...... , below the peritoneum, are entirely extraperitoneal. Their length naturally varies with the size of the individual, and they may be anywhere from 25 centimetres to 32 centimetres long. Nearly 2.5 centimetres of the distal portion of the ureter enters the bladder by passing obliquely through the inferior 98. ...... . Because of the oblique direction the ureter takes through the wall, a full bladder compresses the ureter and prevents the backflow of urine. The wall of the ureter includes a lining of epithelial cells, a relatively thick layer of 99 ...... , and an outer coat of fibrous connective tissue. The epithelium is the transitional type, which flattens from a cuboidal shape as the tube stretches. This same type of epithelium lines the 100. ...... , the bladder, and the proximal portion of the urethra. The ureteral muscles are capable of the same rhythmic contraction that occurs in the 101. ...... . Urine is moved along the ureter from the kidneys to the bladder by gravity and by peristalsis at frequent intervals. When it is empty, the urinary bladder is located below the 102. ...... and posterior to the pubic joint. When filled, it pushes the peritoneum upward and may extend well into the abdominal cavity proper. The urinary bladder is a temporary reservoir for urine. The bladder wall has many layers. It is lined with 103. ...... containing transitional epithelium. The bladders lining, like that of the stomach, is thrown into folds called rugae when the organ is empty. Beneath the mucosa is a layer of 104. ...... , followed by a three-layered coat of involuntary muscle tissue that can stretch considerably. When the bladder is empty, the muscular wall becomes thick, and the entire organ feels firm. As the bladder fills, the muscular wall becomes thinner, and the organ may increase from a length of 5 centimetres to almost three times more. A moderately full bladder holds about half a litre of urine. The trigone is a triangularshaped region in the floor of the bladder. It is marked by the openings of the two ureters and the urethra. As the bladder fills with urine, it expands upward, leaving the trigone at the base stationary. This stability prevents stretching of the 105. ...... and the possible backflow of urine into the ureters. 9. For gaps 106-120 choose the best option A, B, C or D: leads to the outside through the penis, the male organ of copulation. The male urethra serves the 107. ...... purpose of conveying semen with the germ cells and draining the bladder. The urethra in the female is a thin-walled tube about 4 centimetres long. It is located 108. ...... to the pubic joint and is embedded in the muscle of the vaginas anterior wall. The external 109. ...... , called the urinary meatus, is located just 110. ...... to the vaginal opening between the labia minora. The female urethra drains the bladder only and is entirely 111. ...... from the reproductive system. The process of expelling urine from the bladder is called urination or micturition. This process is controlled both voluntarily and involuntarily with the aid of two rings of muscle that surround the urethra. Near the bladders 112. ...... is an involuntary internal urethral sphincter formed by a continuation of the smooth muscle of the bladder wall. Below this muscle is a voluntary external urethral sphincter formed by the muscles of the pelvic 113. ...... . By learning to control the 114. ...... sphincter, one can gain control over emptying of the bladder. As the bladder fills with urine, 115. ...... receptors in its wall send impulses to a centre in the lower part of the spinal cord. Motor impulses from this centre 116. ...... contraction of the bladder wall, forcing urine outward as both the internal and external sphincters are made to 117. ...... . In the infant, this emptying occurs automatically as a simple reflex. Early in life, a person learns to control urination from higher centres in the brain until the time is appropriate, a process known as toilet training. The 118. ...... to urinate will override conscious controls if the bladder becomes too full. The bladder can be emptied voluntarily by relaxing the muscles of the pelvic floor and increasing the 119. ...... in the abdomen. The resulting increased pressure in the bladder 120. ...... the spinal reflex that leads to urination. 106. 107. 108. 109. 110. 111. 112. 113. 114. 115. 116. 117. 118. 119. 120. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. differs duo following gap frontal split vent floor intended widening fuel unwind impulse weight generates B. B. B. B. B. B. B. B. B. B. B. B. B. B. B. diverges dual behind hole front separate channel bottom intentional stretch rouse rest wish heaviness triggers C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. fluctuates twin posterior cavity anterior divided hole ground voluntary extension excite slow longing pressure elicits D. D. D. D. D. D. D. D. D. D. D. D. D. D. D. varies double after opening before disconnected outlet base chosen enlargement stimulate relax itch load starts
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The urethra is the tube that extends from the bladder to the outside and is the means by which the bladder is emptied. The urethra 106. ...... in men and women; in the male, it is part of both the reproductive system and the urinary system, and it is much longer than is the female urethra. The male urethra is about 20 centimetres in length. Proximally, it passes through the prostate gland, where it is joined by two ducts carrying male germ cells from the testes and glandular secretions. From here, it

The Urinary System

10. For gaps 121-140 use ONE word: Urine is a yellowish liquid that is approximately 95% water and 5% dissolved solids and gases. The pH 121. ...... freshly collected urine averages 6.0, 122. ...... a range of 4.5 to 8.0. Diet may cause considerable variation 123. ...... pH. The amount of dissolved substances in urine is indicated 124. ...... its specific gravity. The specific gravity of pure water, used as a standard, is 1.000. Because of the dissolved materials it contains, urine has a specific gravity that normally varies from 1.002 (very dilute urine) 125. ...... 1.040 (very concentrated urine). When the kidneys are diseased, they lose the ability 126. ...... concentrate urine, and the specific gravity 127. ...... longer varies as it does 128. ...... the kidneys function normally. There are several dissolved substances normally found 129. ...... urine: nitrogenous waste products, including urea, uric acid, and creatinine, electrolytes, including sodium chloride and different kinds of sulphates and phosphates and pigment, mainly yellow pigment derived 130. ...... certain bile compounds. Pigments from foods and drugs may also appear in the urine. Examination of urine, called a urinalysis, is one of the 131. ...... important parts of a medical evaluation. A routine urinalysis includes observation of colour and turbidity as 132. ...... as measurement of pH and specific gravity. Laboratories also test for a variety 133. ...... abnormal components. Glucose is usually an important indicator of diabetes mellitus, in 134. ...... the cells do not adequately metabolise blood sugar. The excess glucose, which cannot be reabsorbed, is excreted in the urine. The presence of glucose in the urine is known as glycosuria. The presence of albumin, which is normally retained 135. ...... the blood, may indicate a kidney disorder, such as glomerulonephritis. Albumin in the urine is known as albuminuria. Blood in the urine, known as haematuria, is usually an important indicator of urinary system disease, including nephritis. White blood cells (pus) 136. ...... evidence of infection; they can be seen 137. ...... microscopic examination of a centrifuged specimen. Pus in the urine is known as pyuria. Casts are solid materials which consist of cells or proteins and, 138. ...... present in large number, they usually indicate disease 139. ...... the nephrons. More extensive tests on urine may include analysis 140. ...... drugs, enzymes, hormones, and other metabolites as well as cultures for microorganisms. 11. The italicised words in bold 141-150 have been swapped. Use them in their correct place: The kidney is more prone to disorders than any other portion of the urinary system. Kidney disorders may be acute or 141. common. Acute conditions usually arise suddenly, most frequently as the result of infection with inflammation of the nephrons. These diseases commonly run a course of a few weeks and are followed by
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142. structural recovery. Chronic conditions arise slowly and are often progressive, with gradual loss of kidney function. Acute glomerulonephritis, also known as acute poststreptococcal glomerulonephritis, is the most 143. glomerular disease of the kidneys. This condition usually occurs in children about 1 to 4 weeks after a streptococcal throat infection. Antibodies formed in response to the streptococci attach to the 144. serious membrane and cause injury. These damaged glomeruli allow protein, especially albumin, to filter into the glomerular capsule and ultimately to appear in the urine. They also allow red blood cells to filter into the urine. Usually, the patient recovers without 145. bacterial kidney damage. In adult patients, the disease is more likely to become chronic, with a gradual decrease in the number of functioning nephrons, leading to chronic 146. neurogenic failure. Pyelonephritis, an inflammation of the renal pelvis and the tissue of the kidney, may be either acute or chronic. In acute pyelonephritis, the inflammation results from a 147. chronic infection. Bacteria most commonly reach the kidney by ascending along the lining membrane from an infection in the distal part of the urinary tract. More rarely, bacteria are carried to the kidney by the blood. Acute pyelonephritis is often seen in people with partial obstruction of urine flow with stagnation. It is most likely to occur in pregnant women and in men with an enlarged prostate, because the prostate surrounds the first portion of the urethra in males. Other causes of stasis include 148. permanent bladder, which is bladder dysfunction resulting from neurologic lesions, as seen in diabetes mellitus, and 149. renal defects in the area where the ureters enter the bladder. Pyelonephritis usually responds to the administration of antibiotics, fluid replacement, rest, and fever control. Chronic pyelonephritis, a more 150. complete disease, is frequently seen in patients with urinary tract stasis or back flow. It may be caused by persistent or repeated bacterial infections. Progressive damage of kidney tissue is evidenced by high blood pressure, continual loss of protein in the urine, and dilute urine.

The Urinary System

Glossary afferent - bearing or conducting inward albumin - any of numerous simple heat-coagulable water-soluble proteins that occur in blood plasma or serum, muscle, the whites of eggs, milk creatinine - white crystalline strongly basic compound formed from creatine (white crystalline nitrogenous substance) and found especially in muscle, blood, and urine efferent - conducting outward from a part or organ fascia - a sheet of connective tissue covering or binding together body structures hilum - the indented part of a kidney notch - a V-shaped indentation peritubular - being adjacent to or surrounding a tubule ruga - an anatomical fold or wrinkle (usu. used in the plural) sieve - device with perforations through which finer particles of a mixture of various sizes may be passed to separate them from coarser ones, through which the liquid may be drained stasis - a slowing or stoppage of the normal flow of a bodily fluid or semifluid trigone - a triangular body part; a smooth triangular area on the inner surface of the bladder limited by the apertures of the ureters and urethra turbid - thick or opaque with matter in suspension: cloudy or muddy in appearance urea - soluble weakly basic nitrogenous compound that is the chief solid component of urine