人體的奧秘 - 醫生咁撚好賺唔係無原因 (3)

目錄

(1)基本既心臟介紹
lihkg.com/thread/649350

(2)基本既肺部介紹
lihkg.com/thread/652225

建議由第一期開始慢慢睇
想睇最新目錄請自行起底去最新個post
歡迎留言  一齊討論  你問我唔一定會答
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睇番上兩篇既熱度，結論係 連登係要用個釣魚d既標題先有討論空間
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   Going PeePee is our everyday job. Have you ever wondered where do they come from? Yeah, you probably have already known what organ i'm going to talk about next. It's the kidney. 

    我地每日都要去廁所柯薯薯，你又知唔知柯薯薯背後有咩野? 或者你已經估到啦，今次就係講腎臟 (kidney) 啦。


    The kidney is liked a sewage treatment plant. The difference is, the kidneys filter the blood instead of the sewage. It filters the blood and keeps the blood with the right contents. It also acts as an endocrine organ, but that's not the main point. We'll focus on PeePee in this article. 

    腎就好似一個污水處理廠，唔同既係，污水處理廠過濾水而腎係過濾血。佢幫手Keep住血各種物質既濃度岩岩好。同埋呢，腎其實都係內分泌系統 (endocrine system) 既一個器官，不過唔係依篇野既重點。


    A fun fact to know. Jerking off have nothing done with our kidneys. The semen is literally coming from the testis, i.e. men's eggs. Other than the usage of the urethra, it's hard to find common points. So, masturbation is not likely linked with the renal function. 

    比小小冷知識大家。大家成日話「咪打咁多飛機，小心腎虧啊」，其實呢就錯錯地既。自慰呢其實真係影響唔到幾多個腎，要知道，精子係黎自睪丸 (testis) 既，姐係蛋蛋啊。射精個時除左用同一條尿道之外，真係冇咩共通之處，所以呢自慰唔會點影響個腎，又點打到腎虧呢，始終關係不大嘛，如果唔信，睇落去就知嫁啦。
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    As always, let's take a look into the basic anatomical structure of kidneys. 

    如舊，睇左解剖學上基本既腎臟結構先。

    We have totally 2 kidneys, left and right. A fun fact to know again, the left kidney is located slightly superior than the right kidney because of the smaller left lung. The figure also shows the adrenal glands, that's the parts for renal functions in endocrine. We won't talk about them in this article. 

    我地有兩個腎，左腎同右腎。今次終於差唔多樣啦左右腎，只係左腎個位置高右腎小小姐，因為左肺細D丫嘛。係張圖到可以見到腎上腺 (adrenal glands) ，依個就係腎作為內分泌系統既主要部份啦，腎上腺素 (epinephrine) 就係係到生產，不過唔詳講啦。
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    Let's look into the cross-section of left kidney. 

    睇下腎既橫切面。


    The renal cortex is the outermost tissue of the kidney, acts like the protective walls and sewage entries of the sewage treatment plant, containing the entries for blood to go though the filter system. (not exactly going though but we'll talk about it later on.)

    腎皮質 (renal cortex) 係腎既最外層組織，就好似污水處理廠既牆咁，而且有埋廢水入口。


    The renal medulla is the moise, salty tissue located in the middle of the kidney, acts like the the tanks of the sewage treatment plant, containing fluid with wastes. 

    腎髓質 (renal medulla) 係一個濕既，而且好多鹽既部份，佢係腎既中間部份，就係似污水處理廠既水箱咁。


    The renal calyx is chamber that collect filtered fluid, i.e. urine. Starting from renal caylx, the fluid pasted through is called urine. 

    腎盞 (renal calyx) 係集合過濾液體既地方，係腎盞開始，D液體流過既就可以叫尿液 (urine) 。


    The renal pelvis is the base of the kidneys, collecting urine from renal calyces. 

    腎盂 (renal pelvis) 係腎既底部，集合黎自腎盞既尿。


    The ureter is the duct connecting urinary bladder and renal pelvis, transporting urine. 

    輸尿管 (ureter) 係連接腎盂同膀胱 (urinary bladder) 既管道，用黎運尿。 
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    Futher looks into the kidney. The basic unit of a filtration model is called nephron. Each kidney has about 1.15 million, 1,150,000 nephrons. 

    再睇入D個腎，張圖可以見到腎既基本單位，叫腎元 (nephron) 。每個腎有大概1,115,000腎元。痴撚腺


    Every nephron begins at Bowman's capsule and ends at the entry of collecting tubule, where Bowman's capsule is used to collect waste substances and fluid from capillaries. 

    每個腎元都由鮑氏囊 (Bowman's capsule) 開始，係集尿管 (collecting tubule) 入口結束。鮑氏囊係用黎收集血液中既廢物。


    Inbetween the nephron, there is a network of tubules. (For you to know more, the tubules inbetween can be divided into proximal convoluted tubules, loop of Henle and distal convoluted tubules.) 

    睇完頭尾睇中間，成個腎元既中間都係連住既一條細管道。


    Nephrons are located across the renal cortex and medulla, surrounded by capillaries, with two capillary beds, i,e a network of closely packed capillaries. One is called the glomerulus, another one is called peritubular capillaries. 

    腎元既位置係橫跨腎皮質同腎髓質，比毛細血管包圍住。係每個腎元有兩種毛細管床 (capillary bed) ，第一種叫腎小球 (glomerulus)，第二種叫圍繞腎元毛細管(peritubular capillary)，所謂毛細管床姐係一堆毛細血管 (capillary) pack埋一齊既組織。


    Collecing tubule is the terminal of multiple nephrons, collecting fluid from several nephrons. 

    集尿管 (collecting tubule) 係好多個腎元既終點站，集合各個腎元既液體。

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    Finally comes to the basic physiological mechanism of the kidneys. 

    最後就到基本既腎臟生理作用。


    Before talking about the mechanism, I want to tell you some conceptual ideas of filtration in kidney. 

    係講D生理作用之前，我想講番一D關於腎，概念上既野。


    Although I am using sewage treatment plant as a metaphor of kidney throughout the whole anatomical part, actually they are quite different in physiological part. 

    雖然我一直都用緊污水處理廠做腎既結構比喻，但其實生理作用上就同污水處理廠幾唔同。


    In sewage treatment plant, it is aimed at purifying the contaminated water, so it only focuses on getting rid of the contents inside the water. 

    污水處理廠主要係淨化污水，所以會focus番係整走水入面既污糟野。


    However, in kidneys, it is aimed at homeostasis, i.e. balancing the content of substances in blood. Therefore, it would focus on releasing and reabsorbing of substances. 

    而腎呢，就會focus係體內平衡 (homeostasis) ，姐係平衡番血裡面既成份，所以會釋放內容再重新吸收番。


    Therefore, when we look at the functions of two capillary beds in every nephron, glomerulus is responsible for releasing substances while peritubular capillaries is responsible for reabsorbing substances. 

    所以呢，睇番D腎元有既個兩種毛細管床，腎小球係用黎釋放內容，而圍繞腎元毛細管係用黎重新吸收番D內容。

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    As always, let's take a trip as the blood.  

    都係啦，以血液的角度睇基本既腎臟生理作用。

    (1) The blood is being pumped by the heart, going through the aorta, then renal artery and finally get closed to the glomerulus. 

    (2) As the capillaries in glomerulus are closely packed and grew with pores on them, most of the waste substances and small useful substances passed through the capillary wall and go into the nephron's tubules by the Bowman's capsule. 

    (3) The blood gets out of the glomerulus and goes into the peritubular capillaries, absorbing back the small useful substances from tubules of nephron and the medullary fluid. 

    (4) The blood goes back to the heart through renal vein and inferior vena cava. 

    (一) 血比個心臟泵到去個腎，經過大動脈同腎動脈，跟住D血慢慢行近腎小球。

    (二) 因為腎小球D毛細血管有窿，加上好密集，所以大量既廢物連同細小有用既物質一齊走左出黎，再入左去腎元既鮑氏囊到。

    (三) 咁D血經過左腎小球，再走入圍繞腎元毛細管，係髓質液同埋腎元小管到攞番D有用既物質番黎。

    (四) 最後血入番腎靜脈同腔靜脈，番番去個心臟。

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    Take another trip as the fluid inside the nephron. 

    再以腎元裡面既液體 (係依到叫「前尿」啦，尿既前身) 黎睇。

    (1) The fluid gets diffused from glomerulus and goes into the nephron by the Bowman's capsule. 

    (2) During the trip inside the nephron's tubules and the collecting tube, the fluid released a bunch of substances small useful substances to the surrounding, including, water, electrolytes (Na, K, Cl..) and a little bit of urea. 

    (3) The fluid goes through the renal calyx and becomes urine. 

    (4) The urine goes through ureter to the urinary bladder and waits for PeePee. 

    (5) When the urinary bladder is nearly fulled, the PeePee signal delievered. The urine excapes from urinary bladder, goes through the urethra and finally kisses with the toilet. 

    (一) 咁「前尿」由腎小球滲透出黎，入左去鮑氏囊

    (二)「前尿」經過腎元小管同集尿管，釋放番D物質 (求其舉D例子：鉀、鈣、水、鈉同埋小小尿素) 。

    (三)「前尿」過左腎盞，變成真正既尿液 (urine) 。

    (四) 尿液由輸尿管去到膀胱，等比人柯出黎。

    (五) 膀胱就滿，身體就發出柯尿信號，尿液由膀胱入尿道 (urethra) ，最後走出你既身體。 

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Okay. Finally a successful PeePee 🙂

終於去左次薯薯。

支持打飛機

腎虧就要dialysis

一個post一個器官 係原post會太後唔方便睇

冇錯丫 中西醫對腎既定義係真係唔同
我冇深研過中醫，唔敢肯定
但有時大家講腎虧係真係會唸做西醫個隻

新post 留名

隔離Bio post 絲打

多謝支持

高質
今晚由頭追先

難度上
一直都會係中學bio level
我既目標係要將d野講清楚
唔係刁難
所以呢 一定係中學bio level
小學science都重得
如果係問範圍既
按進度啦
Between
其實從來都冇唸話咩係唔係中學bio
是但啦

點解啲英文硬係怪怪地

中文語系同英文咁唔同
加上我真係唔係語言或者寫文既勁人
唔係寫慣英文真係會怪 sry
尤其我寫個時着重係表達到
咁我英文又唔係perfect
所以有時係會怪怪地
希望你唔好太介意

喂 勁支持你， 雖然我分左好多日睇
真心好鐘意呢啲post!
出多啲呀 講得好清楚

支持 今個sem完左renal block

Renal我最強 諗起條Loop of henle都爽到打飛機

真真正正神奇係個舊countercurrent multiplier effect...

Keep到個osmotic gradient先令樓上講既野成事

佩服樓主中英對照

上個sem 讀 physiology 讀到想喊
希望樓主可以詳細講Immune system
因為我讀完都唔知jm9

打得多個腰會有啲痛

renal d acid base balance physiology 複雜到仆街

其實呢啲嘢，分開啲 physiology 嘢同 clinical 嘢就冇問題。

真係想學好啲 physiology 嘅話，就要逐段 tubule 學識每個 transporter 嘅用處；如果你學識呢啲嘢，你就會可以由 physiology derive 返每個病點解會有咁嘅現象。當然，咁做會用好多時間。我當年真係用咗兩年先真正學識成條 renal tubule 每部分係點work，and even then 三四年之後有好多嘢都有新嘅發現、新嘅見解。

不過又咁講，除非你真係想做 renal / icu / anaes (and perhaps chem path) 否則學呢啲嘢即使識飛都唔會幫到你好多，夠就得。

《以下係懶嘅方法》

首先，要明白 proximal tubule 同 distal tubule 分別做啲咩嘢。 proximal tubule acidify urine 嘅方法係吸返啲 bicarbonate，而 distal tubule 嘅做法係放 ammonia 走。其它嘢，除非你真係諗住做 physiologist 否則唔會有太大用。

然後係 compensation；ABG 要計 compensation，其實只要記 pCO2 (mmHg) = 15+bicarbonate (mmol/L) 就可以 (metabolic alkalosis 同 acidosis 都係一樣)；至於 respiratory acidosis/alkalosis，鬼會計咩。

利申：教 tutorial 教到出煙嘅低級職員

巴打教開med physi?
Bookmark左呢招
個思維係幾方便
唉你知啦dse 連果d pka呀 handerson hasselbach都無教
到學 renal physi 呢d 好講concept既位就煩好多