About an hour ago I was on the verge of ripping my g.d. kidney out of my body and throwing it out of the window. Luckily there are no windows in my study-dungeon, so my mind had a moment to wander:
Hmmm, what arteries am I going to have to sever in the process? Renal artery and renal vein obviously, and maybe that stupid splenorenal ligament. Oh and what should I do about my ureter, that could get messy. I should probably rip out the left one because the ureter is longer and then I can donate it. But I want to jump up and down and stomp on it, not donate it. Will ripping out one kidney increase the renal plasma flow (RPF) of the other kidney? Will the glomerular filtration rate (GFR) increase? Will an increased GFR lead to increased Na+ delivery to the macula densa in the distal tubules of the nephron and then lead to decreased renin secretion, decreased aldosterone production, hyperkalemia and hypotension? No, none of that makes sense. You have it all backwards and that is why you wanted to rip out your kidney in the first place. Stop thinking about your kidneys.
Okay. So I’ll go on a run.
It’s hot out. I’m out of shape. I can feel my heart beating. Increased cardiac output. Hmmm, cardiac output equals stroke volume times heart rate. Which one is increased right now? Both. I’m increasing sympathetic outflow, oh and I’m constricting my renal artery– take that, you godforsaken kidney. Okay so blood flow to an organ is proportional to it’s metabolic activity, and my muscles are working hard right now. Blood flow is increasing. How? Vasoactive metabolites (CO2, H+, adenosine, lactate, etc)! They cause vasodilation. Vasodilation? That’s also what causes an erection. Mechanism of sildenafil? Increase nitric oxide (NO) which will bind to guanylate cyclase, increase levels of cGMP, smooth muscle relaxation and boom, you’ve got an erection. Do not take with nitrates, it will cause severe hypotension.
It never ends!
This evening I begin G.I. You know what that means? H. Pylori (booooring), over prescribed (?) Proton Pump Inhibitors, Familial Adenomatous Polyposis (was that the APC gene? Autosomal Dominant, no?), and lots and lots of diarrhea. Cha cha cha.
This, my friends, is the life of a medical student.
21 days until I take the boards.