all right appropriately we're discussing the digestive system and I trust you all digested well over the holidays and enjoyed this so let's continue with the second largest gland the pancreas what was the first largest gland I'm waiting for you I'm waiting for him thank you all right thank you all right the second largest gland this gland then has two main types of cells the exocrine and endocrine and the exocrine cells are called asiner cells asiner cells and they secrete enzymes which go into ducts secrete enzymes into Ducks and the Ducks eventually converge into a duct which joins the bile duct and this duck then liberates the contents into the dood denum two pancreatic enzymes would be examples kimot Trion and K and no trp cinogen kimot triogen and trp cinogen then the Endocrine cells are called the eyelets of longer Han and these eyelids then are scattered in little groups amongst the asiner cells by far the greatest number of cells are asiner cells then eyelets there are more eyelets in the tail of the pancreas than in other parts of the pancreas we may have mentioned previously the location of the pancreas so you can see where the tail is if we have the stomach coming in awful lot of noise do you know what's causing that no this is our stomach this is our Pyar spincter so that makes this what dood and we'll find that the pancreas then going to switch with me yeah thank you check one two 2 3 4 check one two 3 4 yeah all right we'll see how that is hope it's a little quieter for you thank you very much so we want to put then the pancreas in between the stomach and the dood denum here give it a little more of a tail so in yellow we have our pancreas which will then have a h head a neck a body and a tail so head neck body and tail and we said most of the eyet cells are down in the tail so the eyelet cells are of different type we have alpha cells beta cells and Delta cells and each secretes a different hor whoops a different hormone the alpha cells secrete what glucagon and that will raise blood sugar the beta cells insulin which will lower blood sugar and the Delta cells somato Statin somato sattin which will inhibit other pancreatic hormones anybody know anyone who's had pancreatic cancer how are they doing they died yes used to be within a year after you hear from pancreatic cancer that they died but I've been told now they're having greater success to carry them through so if you have somebody tell them that there are some positive outlooks but it used we just all dreaded getting panre iotic Cancer all right with that small introduction to the pancreas let's move on to the kidney let's just call it the urinary system to start with that's better so our urinary system is designed then to form urine and excrete uide so we need several structures involved here we're going to have two kidneys and they will be involved in forming [Music] urine and we'll have two uror that will excrete let's put just pass urine we'll have one urinary bladder so now after taking Anatomy you know you have to when you say bladder classify whether it's urinary or Gall and this will store some people say and concentrate urine seen it in some books not in others and then one urethra and the urethra then will convey the urine to the exterior so let's take our kidneys first then and see how they form urine first what's the size of a kidney between four and five in long two to three Ines wide and one in thick these will vary did I tell you when we were teaching in Venezuela they thought we were urologists and not neurologists and they took us into a room filled with urologists and I looked at my husband he looked at me what are we going to do and I said well I'll ask him a simple question what's the difference between the right and left kidney guess what we discussed they' never thought of it does it make a difference when you transplant they had never thought of it a kidney was a kidney we gave them lots to think about and we were completely ignorant other than what I know in my basic anatomy anyhow so it shows you what you've got a lot of adrenaline you can bring things out rapidly and I can tell you lots of stories that way but I won't we'll continue on why we learn about kidneys then we want the location of the kidney it's going to be on our posterior abdominal wall posterior abdominal wall and it will be posterior to the parietal parium post posterior to parietal peritoneum which lines the abdominal wall but it's posterior to parietal peritoneum so it's called retr paranal retro par tone eel important to know what structures are r retr paranal so if they are producing something abnormal it won't get into the parital cavity it's retro perianal now how do we Define where it is on this posterior abdominal wall it'll make a difference whether it's the left or the right kidney the left kidney is this is left kidney it's going to be between T12 L1 L2 L3 so we'll have the upper pole up here at T12 and the lower pole down at L3 now do you think the right kidney is going to be higher or lower and defend your answer no idea it's going to be lower because we have the right lobe of the liver over here so it has to be lower to be below the liver we don't have the right the big lobe on the left side so the right kidney is lower than left because of large right lobe of liver so that's location that's size now let's begin to look at structure first we'll look at external structure when you define the shape of a kidney to somebody you say it's Bean shaped when you define a bean to somebody you say it's kidney shaped but we know what you're talking about so it's Bean shaped the indentation is called the hus and in the highas we'll have the renal artery coming in where's the renal artery coming from thank you perfect we learned that again the importance of knowing that relationship when we learned about the abdominal aorta in Monty Paxton's lecture on the vascular surgery then we have the renal vein entering at the High and I'll have to sort of overlay it or maybe what I'll do is make another one we'll have the renal pelvis what's pelvis me basin here we have the renal pelvis coming out and it will continue into the urer so that gives us some basic landmarks one more let's no let's go internal this is just internal we'll have the cortex and the Mulla what do cortex mean bark good for you that was quick now we're going to look at the internal tub tubular structure we're going to kidney is just masses of tubules we have those which are secretory and those which are excretory the secretory will consist of got to want to be sure I give you the special name that I don't mix it up here secretory will be will be the nefron and the nephron is the structural and functional unit of the kidney what's the structural and functional unit of the liver lul how about compact bone we've learned them haven't we and muscle all right so now what's the nefron consist of we have the secretory component and it will have the Bowman's capsule I hope you corrected one of the students saw it was misspelled up there I didn't write clearly when I turned that in today to be type so I apologize so it should have been Bowman's capsule Bowman's cap capsule and glomerulus and this is called the renal cor pusle and we then have the renal tubules and these will be the proximal convoluted tubule proximal convoluted tubule the loop of Henley have you ever known a Mr Henley they have rare names don't they distal convoluted tubule and these are our renal tubules and these then all make up our nefron our unit so we'll start put some functional significance into this group of tubules ever thought about how many structures in your body are tubules how many of our systems we had the respiratory we had the digestive we had the nervous now we're getting our urinary all tubules so we're going to start with our Bowman's capsule it's going to have two layers now we want to leave lots of room because we've got to go down we've got to go wide and we've got to go up so we're going to put the capsule right in about here we have an outer layer outer what are you going to call the outer layer oh that should be so fast paral right right parietal parietal layer of Bowman's capsule will be one and it will consist of simple squamous epithelium and and inner layer what are you going to call the inner layer visceral right visceral layer of Bowman's capsule I'm just going to write it out it's a visceral layer and the visceral layer consists of what are called podo sites podo sites foot cells and these are to allow for filtration it's hard to draw them but you get the sort of general idea that you have a cell with little foot processes and these foot processes sit on the basement membrane so that filtration can come through these openings between the foot processes for filtrate so with this I want to introduce the term glomerulus which is the other component of the nefron in this region the glomerulus now we're not going to go through all the arteries which lead to it but our purpose in forming a nefron as we said was to filter plasma make a glomular filtrate which will eventually form urine so we have to have the structures that will carry these functions out so we've got to bring the blood supply into our Bowman's capsule it'll be coming in as an afferent arterial now leave room here because we've got to bring other things above it this will be call it three here move it over three equals an aarant arterial blinging in arterial blood it's going to break up into a massive capillary bed that comes right against our poyes in our visceral layer and this will be four four will be the glomerulus so that's a capillary bed which will be bringing in arterial blood and then after the filtrate has been formed the blood continues on as the eant arterial e for exit five is our epher arterial so now our purpose is to form a filtrate that is going to start collecting in this series of ducts that we want to develop so for blood to form a GL glomular filtrate the plasma will go through we go from the capillary endothelium then through the poite then through the basement membrane and then we will have glomular filtrate what do you think's the most important structure here to be getting our glomular filtrate basement membrane the basement membrane will not allow molecules over 70,000 with a molecular weight molecules with molecular weight over 70,000 not pass basement membrane how would you like the job in the lab of isolating the basement membrane they were doing this in Copenhagen back in the 60s tremendous progress since then right all right now we formed our filtrate we want to continue on with our picture to see what happens to get us some urine but in order to do this let's find out how much blood goes through the kidneys each minute well it said 12200 CC's blood out of that and 25 cc's of glomular filtrate and out of that 124 cc's of glomular glomular filtrate are reabsorbed so how much urine do we get one c c you think you could design a kidney more efficient what have we got 1,200 cc's of blood is needed to extract one cc of urine this is 125 sees a filtrate per minute picture your kidneys you see them there never think about them just get mad if they don't work or if they work too efficiently after a beer party and here we are 124 reabsorbed you guess it that's the end product is that amazing yeah we've got this for later but I think that's pretty dramatic to have a gland functioning in one minute for that kind of processing in your body and you've never ever thought of it before all right now we've got to follow to see what's happening where this glomular filtrate is coming down now see we've made our filtrate it's got to go through our tubular system so we first encounter the we're going to draw it and then come back and speak about it all right we're going into the proximal convoluted tubule we're just going to make one convolution here even though they're hundreds as a representative sample this will be my proximal [Music] convoluted tubule this will be our Loop of Henley that's the descending limb and now we'll go back up with the ascending limb ascending limb and it will come all the way up now this is why I asked you to keep space up here that was our afir arterial got to take it off at the moment take it all the way up all the way up clear around I'm going to switch these because I want this to come around and out and I want it to be the this one should be I want an inner coming in like this there we go so that makes our distal convoluted tubal and gets us through our nefron so now what's happening what is our why do we need these and what are the differences between or amongst them so let's take our proximal convoluted tubule most of your cortex consists of proximal convoluted tub so it will be lined with cuboidal cells with a brush border just look like a brush when early with the light microscope with the electron microscope they learned that the brush border is actually microvilli so as we had in the intestine increasing surface area by having microvi show pictures of these they're very distinct now the what's the function here of my posterior convoluted by did I say post Pro proximal should be proximal convoluted Tule number one it's going to absorb 100 cc's of water it's going to absorb any glucose that comes in it will absorb amino acids you don't want protein in your urine amino acids it will absorb sodium ion and vitamin C tremendous reabsorption going on in all of those proximal convoluted tubules how about the loop of Henley the descending limb will be reabsorbing water the ascending limb will reabsorb sodium ion and chloride now what's left for the distal convoluted tubule we'll have water we'll have calcium ion will have phosphate and sodium but something different is happening in the distal convoluted tubule rather than just absorption we'll have secretion this is absorption with all of these and then there'll be secretion what's being secreted hydrogen ion and potassium ion hydrogen ion and pottassium so tremendous ion exchange going on within your kidneys but now say that you have low blood pressure and you have low sodium did he click yes okay well then I'll give this next time because I want you to see the slides while it's fresh with this first slide please thank you this is just to show the position of the pancreas here with the head would be over they're a little bit distorted you'll learn all about the amum and all these membranes when you take Advanced Anatomy but this is the head would be here in the body here and the tail here neck in between in the next one now this is a very special stain maler Aon and it shows these are asiner cells with this particular stain you can truly pick up the eyelets of longer Han in the pan pancreas but this is a r rare stain what you'll usually get in pathology is the next one next slide now where do you see here are eyelets here these are aeter stains this is with an iron hematoxilin and analin blue stain entirely different but showing what staining can do to demonstrate structure in the next one and now we're in the cortex of the kidney at has a connective tissue membrane a good thick protective one here's our glomerulus in the Bowman's capsule this would be the parietal layer the visceral layer is adherent to the capillaries in the form of poyes now most of these are proximal convoluted tubules in the next one now this is showing the blood supply coming in the interlobar arteries there are arteries then an interlobular artery comes on up and gives off the glal via the AFR arterial but you can see this is the glomerulus in the next one and this is with an India ink injection into the vascular Supply so you can see the main trunks coming up the interlobular ones and then the aparant coming in not all of them will have both because this is is a big ball and just you'll get a section which will show both in next next please now this is the Bowman's capsule to show you it truly is just a simple squamous capsule this is the area between the parietal layer and the visceral layer which is adherent to the capillaries bed here and you're going to be collecting the filtrate in here in the next one and this shows this is just a normal uh iron let's see this is hematoxyline eosin stain you have the parietal layer then the visceral layer adherent again to the endothelium in the next one now we have here an afferent arterial coming in this is a rare one and the eant is it no it's going to be coming out over here no what is this that's the beginning of the uh tubular system so it's difficult to determine which is afferent and which is eent here but on the slide it says it shows both afferent and ephant so it has to be one of these and this would be your tubular system collecting the glomular filtrate that's a rare slide I've never seen one like this before in the next one and this now shows cross-sections of your proximal convoluted tubule you see the blue that's your brush border that's the way it looks with the light micrograph but it's in reality microvilli for absorption 100 cc's has to come back in of water in this proximal convoluted tubule in the next one and here's another different stain to show how Mark but you can see why early anatomist called it a brush border in the next one and now what's this pardon everybody should know that what is it I'll wait until you say where does the filtrate go as it leaves the proximal convoluted tubule into the loop of Handley see isn't that a beautiful Loop have you ever seen a slide like that that actually catches it amongst all these tubules so that's the loop of Henley the layer going down is thinner than the layer coming back up in the next one and this is now going to be one of the collecting ducts because after the urine leaves the nefron it enters collecting ducks in the next one and these are collecting ducks in cross-section so you see this would be Loops of Henley down here in cross-section but the big ones are now collecting ducks in the next one that's it all right enjoy your afternoon e