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Recently, protein has appeared in John’s urine. Deduce which part of the nephron must be damaged and justify your answer.

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It was found that John had glucose in his urine 2 years prior when he was first diagnosed with diabetes. Explain the mechanism behind the presence of glucose in his urine.

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Explain why Jamie has a bluish coloration in his extremities and his enlarged right ventricle.

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Describe the other abnormalities in the labelled structures of the heart in the scan.

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Identify the nephron structures 1-4 on the diagram.

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Describe the flow of oxygenated and deoxygenated blood through the heart, great blood vessels, lungs and rest of the body in a normal healthy person. Make sure you include the great blood vessels, chambers and valves of the heart.

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Deoxygenated blood from the body enters the right atrium through the inferior and superior vena cava. The deoxygenated blood then travels through the tricuspid valve into the right ventricle before exiting the heart via the pulmonary valve into the pulmonary artery and travelling towards the lungs. Oxygenated blood from the lungs enters the left atrium via the pulmonary vein. It passes through the bicuspids into the left ventricle and then exits through the aorta valve into the aorta to be pumped around the body

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The aorta and the pulmonary trunk are on the wrong sides of the heart. The aorta should be above the left ventricle and the pulmonary trunk should be above the right ventricle.

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As the aorta and pulmonary trunk are on the wrong sides of the heart, the deoxygenated blood that is entering into the aorta is being pumped throughout the body without entering the lungs to become oxygenated. This also means that the blood entering the left ventricle is pushed to the lungs to become oxygenated before re-entering the left ventricle before being deoxygenated. With no oxygen to give the haemoglobin its red colour in the right ventricle,  Jamie begins to get bluish coloration of his extremities as the deoxygenated blood spreads through his body. Additionally, the right ventricle becomes enlarged due to the new stress of pushing this blood to the whole body rather than to just the heart.

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1 - bowman’s capsule

2 - glomerulus

3 - proximal convoluted tubule

4 - descending loop of henle

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The glomerulus must be damaged if protein has appeared in the urine. In normal functioning of the glomerulus, the glomerular filter will only filter small molecules such as water, glucose and amino acids into the Bowman’s capsule and will not filter protein and blood cells, which will remain in the capillaries. Thus, for protein to have appeared in urine it must have initially passed through the glomerular filter, meaning that the glomerulus must be damaged if it cannot retain large molecules in the capillaries.

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Diabetes is a condition in which the body cannot produce enough insulin to absorb and store glucose in the body. As a result, a buildup of glucose remains in the blood. As glucose is easily filtered through the glomerulus, an increase in blood glucose levels directly causes an increase in the amount of filtered glucose to an extent that it is too much for the proximal tubule to reabsorb and hence, more glucose is excreted in the form of urine.

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Oxygenated blood enters the heart through the pulmonary vein, coming from the lungs. The pulmonary vein connects to the left atrium, where oxygenated blood flows through the bicuspid valve to the left ventricle. This blood is pumped up through the aorta to be delivered to the rest of the body. Once this blood has flown through the body, it returns to the right atrium of the heart deoxygenated through the superior and inferior vena cava. Blood travels to the right ventricle through the tricuspid valve. From the right ventricle, it is pumped through the pulmonary artery to the lungs to be reoxygenated.

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The aorta on this diagram is connected to the right ventricle, rather than the left ventricle, and the pulmonary trunk is connected to the left ventricle. This means that the blood coming from the lungs to the left atrium is being recirculated to the lungs via the pulmonary trunk, and the blood circulating the body is not being reoxygenated in the lungs, but rather is coming back into the right atrium and to be sent out to the body again through the aorta.

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The deoxygenated blood arrives at the right atrium through the vena cava. The blood travesl travels throught the tricuspid valve and enters the right ventricle. The bloods leaves the right ventricle to the pulmonary artery through the pulmonary valve and arrives at the lungs. The blood become oxygenated and travels back to the heart through the pulmonary vein. The oxygenated blood arrives the letf atrium. It pass through the bicuspid valve and enters the left ventricle. The blood pass throught the aortic valve and leave the heart via the aorta.

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The right ventricle is connected to the aoter while in a normal person, the aoter should be connected to the left ventricle. In this case, blood are circulated through the body without going to the lungs and getting blood oxygenated. The muscles on the left ventricl is think where in a normal person the heart muscle in the lfet ventricle should be thick

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deoxygenated blood moves from the body's veins to the heart via the vena cava entering the right atrium, blood moves from right atrium through to the right ventricle, passing through the tricuspid valve. Right ventricle pumps deoxygenated blood through the pulmonary valve towards the lungs via the pulmonary artery. Blood is then oxygenated in the lungs, where it then travels back to the heart's left atrium through the pulmonary vein. Oxygenated blood moves from left atrium to the left ventricle, passing through the bicuspid (mitral valve). Blood from the left ventricle is then pumped past the aortic valve, which then flows to the rest of the body via the aorta. 

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deoxygenated blood moves from the body's veins to the heart via the vena cava entering the right atrium, blood moves from right atrium through to the right ventricle, passing through the tricuspid valve. Right ventricle pumps deoxygenated blood through the pulmonary valve towards the lungs via the pulmonary artery. Blood is then oxygenated in the lungs, where it then travels back to the heart's left atrium through the pulmonary vein. Oxygenated blood moves from left atrium to the left ventricle, passing through the bicuspid (mitral valve). Blood from the left ventricle is then pumped past the aortic valve, which then flows to the rest of the body via the aorta. 

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The deoxygenated blood is going back to the body with out going to the lungs. It means that the blood are low in oxygen level. There is not enough blood supply to the body and it causes the extremities to have a bluish colour. The right ventricle will have to pump the blood from the heart to the rest of the body which increases the workload of the right ventricle and enlarges it.

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The aorta is connected to the right ventricle and the pulmonary trunk is connected to the left ventricle. In a typical heart, the aorta is connected to the left ventricle and the pulmonary trunk is connected to the right ventricle. In this patient, the major blood vessels are 'inverted' in their position. 

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The aorta is connected to the right ventricle and the pulmonary trunk is connected to the left ventricle. In a typical heart, the aorta is connected to the left ventricle and the pulmonary trunk is connected to the right ventricle. In this patient, the major blood vessels are 'inverted' in their position. 

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1 Glomerulus

2 Bowman’s Capsule

3 Proximal Convoluted Tube

4 Descending limb

5 Loop of Henle

6 Thick ascending limb

7 Distal Convoluted Tubule

8 Collecting Duct

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Diabetes leads to the presence of glucose in his urine due to changes in blood glucose levels. Diabetes causes insufficient production of insulin, preventing cells from uptaking glucose present in the blood. This leads to a high concentration of glucose circulating in the blood. When this blood passes enters the kidney via the glomerulus and Bowman's capsule interaction, the concentration of glucose exceeds the threshold level of glucose reabsorption in the proximal convoluted tubule - the nephrons are not able to reabsorb all the glucose passing into them. Hence, glucose remains present throughout renal filtration

# data[].attributes.subject
Diabetes leads to the presence of glucose in his urine due to changes in blood glucose levels. Diabetes causes insufficient production of insulin, preventing cells from uptaking glucose present in the blood. This leads to a high concentration of glucose circulating in the blood. When this blood passes enters the kidney via the glomerulus and Bowman's capsule interaction, the concentration of glucose exceeds the threshold level of glucose reabsorption in the proximal convoluted tubule - the nephrons are not able to reabsorb all the glucose passing into them. Hence, glucose remains present throughout renal filtration

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Glucose is circulated throught the body by blood. In people without diabetes the Beta Cells in the liver produce enough insulin to assist with absorption of insulin into cells. However, In type 2 diabetes not enoguh insulin is produced to tightly regulate amount of insulin the blood. Therefore, the glucose in the blood will exceed the renal threshold of 2mmol and get expelled in the urine.

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1 - Bowman's capsule; diffusion of products out of blood2 - glomerulus; bundle of capillaries 3 - proximal convoluted tubule; returns glucose4 - descending limb; water moves out into medulla 5 - loop of Henle6 - ascending limb; sodium and chloride move out into medulla7 - distal convoluted tubule; regulate potassium and acidity 8 - collecting duct; collection of water 

# data[].attributes.subject
1 - Bowman's capsule; diffusion of products out of blood2 - glomerulus; bundle of capillaries 3 - proximal convoluted tubule; returns glucose4 - descending limb; water moves out into medulla 5 - loop of Henle6 - ascending limb; sodium and chloride move out into medulla7 - distal convoluted tubule; regulate potassium and acidity 8 - collecting duct; collection of water 

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Something is damaged in glomerulus. Glomerulus is a site of filtration of blood from capillaries into the kidneys, but large particles like blood celss and proteins are not supposed to be able to go through the glomerulus filter. As there is no mechanism in the kidney that is designed for reabsorption of proteins, it will end up leaving through urine.

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By being connected to the wrong great blood vessels, blood entering the right side of the heart is not pumped towards the lungs but is rather pumped back out to the rest of the body. This leads to the creation of two separate circuits of blood flow between the sides of the heart, preventing sufficient oxygenation of the blood. This leads to low oxygen supply to the extremities, due to insufficient oxygenation of circulating blood, leading to the bluish extremities. Enough oxygenation occurs from the action of capillaries around the lungs that some oxygenation still occurs but is only enough to properly support the structures within the torso. The enlarged right ventricle is a function of increased strain and demand out of the muscles of the right side of the heart to match the rate of blood flow out of the left; in a healthy, normal individual, the distance of which the right ventricle would need to pump blood is much less - from the heart to the lungs - meaning less need for musculature to produce force. 

# data[].attributes.subject
By being connected to the wrong great blood vessels, blood entering the right side of the heart is not pumped towards the lungs but is rather pumped back out to the rest of the body. This leads to the creation of two separate circuits of blood flow between the sides of the heart, preventing sufficient oxygenation of the blood. This leads to low oxygen supply to the extremities, due to insufficient oxygenation of circulating blood, leading to the bluish extremities. Enough oxygenation occurs from the action of capillaries around the lungs that some oxygenation still occurs but is only enough to properly support the structures within the torso. The enlarged right ventricle is a function of increased strain and demand out of the muscles of the right side of the heart to match the rate of blood flow out of the left; in a healthy, normal individual, the distance of which the right ventricle would need to pump blood is much less - from the heart to the lungs - meaning less need for musculature to produce force. 

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Diabetes prevents the regulation of blood glucose by inhibiting the production of insulin and glucagon, which allow the body to take up and store, or release glucose into the bloodstream. Over time, glucose levels build up in the blood which enters the kidneys to be filtered by the nephrons. Due to the large surface area of the glomerulus, the high levels of glucose readily diffuse through the Bowman’s capsule and enter the nephron. In the proximal convoluted tubule, glucose is reabsorbed from the filtrate, however the concentration of glucose in John’s blood would have been too high to be completely reabsorbed by the surrounding cells. Hence, the glucose travels through the nephron and is excreted in his urine.