Med Term 3 > Urinary 7 > Flashcards

Urinary 7 Flashcards

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1
Q

What is the ability to store urine called?

A

continence

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2
Q

What are the two phases of micturition?

A
  1. continence phase
  2. voiding phase (micturition)
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3
Q

What is entailed in the two phases of micturition?

A
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4
Q

What nervous system is the Storage / Continence Phase controlled by?

What is the pathway?

What is the effect?

A

sympathetic nervous system (T10-L2)

cortical storage centres -> pontine storage (lateral) -> sympathetics (T10 - L2)

effect:
- relax detrusor muscle (bladder wall stays floppy)
- contract internal sphincter (so urine stays)

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5
Q

What nervous system is the Voiding Phase controlled by?

What is the pathway?

What is the effect?

A

parasympathetic

  • cortical voiding centres -> pontine voiding (medial) -> parasympathetic S2-S4 and somatic S2, S3, S4

effect:
- detrusor muscle contracts
- internal sphincters relax

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6
Q

How much urine can the bladder hold in a normal bladder?

A

around 550ml (from 300 to 700ml)

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7
Q

What is the urinary flow rate in a full bladder in men and women?

A

20-25ml/s in young men (about 24 seconds)

25-30ml/s in pre-menopausal women (around 22 seconds)

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8
Q

What part of the bladder acts a temporary urine storage?

A

body

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9
Q

What part of the bladder connect the neck to the urethra?

A

internal urethral orifice

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10
Q

What is the name of the bladder feature which is marked by the two ureteric orifices (top corners) and the internal urethral orifice (bottom corner)?

A

trigone

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11
Q

What tissue is the trigone made of? How is this different to the tissue in the rest of the bladder?

A

smooth mucosa - rest of bladder has folds but trigone stays smooth which helps guide urine efficiently toward the urethra

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12
Q

What embryological origin does the trigone arise from?

A

formed from mesonephric ducts while rest of bladder is endoderm

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13
Q

The trigone is a common site for what? Why?

A

infections/cystitis because urine pools there

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14
Q

What does the body of the bladder do?

What is the trigone?

What does the neck of the bladder do?

A

acts as a temporary store of urine

triangular patch inside bladder marked by the two ureteric orifices and the internal urethral orifice

connects bladder to urethra

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15
Q

What are the important three muscle components of the bladder?

A
  1. detrusor muscle - involuntary - smooth muscle
  2. internal urethral sphincter - involuntary - smooth
  3. external urethral sphincter - somatic, voluntary
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16
Q

What forms the external urethral sphincter?

A

pelvic floor muscles

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17
Q

Label the image.

A
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18
Q

What are the 3 nerves that directly innervate the bladder?

A

hypogastric - sympathetic

pelvic - parasympathetic

pudental - somatic

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19
Q

From which spinal cord segments do parasympathetic fibers to the bladder arise?

A

S2-S4

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20
Q

What is the preganglionic neurotransmitter for parasympathetic control of the bladder?

A

Ach

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21
Q

Which nerve carries parasympathetic fibers to the bladder?

What muscle does this control and via what neurotransmitter?

A

pelvic nerve

  • detrusor: Ach and ATP
  • internal urethral sphincter: NO
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22
Q

Which receptors mediate detrusor contraction in parasympathetic stimulation?

A

muscarinic M3 receptors

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23
Q

From which spinal cord segments do sympathetic fibers to the bladder arise?

A

T10 - L2

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24
Q

Which nerve carries sympathetic fibres to the bladder?

What muscle does it act on and via which neurotransmitter?

A

hypogastric nerve

  • detrusor: NE
  • internal urethral sphincter: NE
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25
What is the effect of sympathetic stimulation on the internal urethral sphincter? Via what receptors?
contraction via a1-adrenoreceptors
26
Which receptor mediates sympathetic relaxation of the detrusor?
b2 or b3 adrenoreceptor
27
Which neurotransmitter is used by sympathetic postganglionic fibres in the bladder?
NE
28
What is the neurotransmitter at the neuromuscular junction of the external urethral sphincter?
Ach
29
Which receptor mediates contraction of the external urethral sphincter under somatic control?
nicotinic
30
What is the detrusor muscle formed of? How is muscle orientated in the detrusor? Why is this?
formed from a plexiform meshwork of smooth muscle fibres in roughly 3 directions - two longitudinal and one circular -> gives strength to the bladder irrespective of the direction in which it is stretched
31
Label the different layers.
32
Label the images.
33
When do the stretch receptors start signalling the need to void the bladder?
when bladder is filled to around 400ml
34
What does ACh do? (parasympathetic) What does ATP do? (parasympathetic)
contracts detrusor via M3 receptors = promotes voiding co-transmitter that contracts the detrusor via P2X (purinergic) receptors
35
What does NO do? (parasympathetic)
relaxes internal sphincter muscle = facilitates voiding
36
What does NE do? (sympathetic)
contracts internal sphincter via a1-adrenoreceptors = storage relaxes detrusor via B3 > B2 adrenoreceptors
37
Through which ganglia do sympathetic fibres to the bladder synapse? Which nerve carries sympathetic fibres from this ganglia and to the bladder? From which spinal cord segments do sympathetic fibres to the bladder arise?
inferior mesenteric ganglia hypogastric nerve T11-L2
38
How does the spinal cord send signals to the bladder to store urine? (mention the fibres, origin, neurotransmitter, pathway and effects)
39
How does the spinal cord send signals to the bladder to void urine? (mention the fibres, origin, neurotransmitter, pathway and effects)
40
How does the spinal cord send signals to the bladder to voluntarily hold urine? (mention the fibres, origin, neurotransmitter, pathway and effects)
41
What is the purpose of the somatic motor nerves?
voluntary hold pudental nerve -> external sphincter -> contraction = voluntary control of urination
42
What is the purpose of the parasympathetic fibres?
void urine pelvic nerve -> pelvic plexus -> bladder wall contracts detrusor = squeezes bladder relaxes internal sphincter = opens outlet
43
Parasympathetic control does what to the bladder and via which nerve, neurotransmitter and receptors?
contracts detrusor via M3 receptors relaxes internal urethral sphincter via NO pelvic nerve Ach
44
Sympathetic control does what to the bladder and via which nerve, neurotransmitter and receptors?
stores urine - detrusor relaxes via b3 receptors - internal sphincters contracts via a1 receptors hypogastric nerve NE
45
What happens during the storage phase? What happens during the voiding phase?
46
Pontine Micturition Centre is also called what?
Barrington's Nucleus
47
What does the lateral region of the PMC control? What would occur if it was stimulated?
continence - storage of urine powerful contraction of urethral sphincter
48
What does the medial region of the PMC control? What would occur if it was stimulated?
micturition centre decrease in urethral pressure and silence of pelvic floor EMG signal followed by rise in detrusor pressure
49
Bilateral lesions in the lateral pons of the storage centre would lead to what?
- inability to produce urine - reduction in bladder capacity - excessive detrusor muscle activity - relaxation of urethra - premature voiding - incontinence
50
Bilateral lesions on the Dorsomedial Pontine tegmentum would lead to what?
- severe urinary retention
51
Damage to what region of the PMC would lead to a leaky bladder and premature voiding?
(bilateral lesions) lateral pons
52
Damage to what region of the PMC would lead to severe urinary retention?
(bilateral lesions) dorsomedial pontine tegmentum
53
What makes the bladder distensible?
highly folded walls - rugae
54
What happens to the internal urethral sphincter and rugae during bladder filling/storage phase?
internal urethral sphincter - tightens/close rugae - flatten
55
As the bladder fills up with urine, what pressure hardly changes?
intravesical pressure hardly changes
56
Label the image.
57
Actions of the medial pons will bring about what?
58
What receptors are stimulated when the bladder fills? What then occurs?
stretch receptors in the wall of the urinary bladder 1. afferent fibres transmit the impulse to the spinal cord: - stimulation of interneurons that transmit sensation to the thalamus and, via projection fibres to the cerebral cortex - stimulation of parasympathetic motor neurons in the sacral spinal cord
59
How many ml of urine remains in the bladder at the end of normal micturition?
<10ml
60
What is the area between the ureteral openings and the urethra which funnels the urine into the urethra?
trigone
61
What enables involuntary control of the release of urine from the bladder? What is this made of?
internal urethral sphincter - smooth muscle
62
What is the definition of urinary incontinence? List 3 ways by which it can impact someone.
complaint of any involuntary leakage of urine - impact on quality of life - social exclusion - sense of shame
63
List risk factors for urinary incontinence.
64
List 3 things that can cause incontinence.
- UTIS - stress incontinence (pelvic floor injury) or secondary to childbirth - generic loss of muscle tone in elderly individuals - damage to the CNS, spinal cord or the nerve supply to the urinary bladder or external sphincter
65
List 2 causes for urinary retention.
- BPH in men - kidney stones
66
What are the classifications of LUTS?
67
List 5 class of drugs that could cause urinary retention.
- drugs with anticholinergic properties e.g antihistamines - narcotic analgesics e.g opiates - alpha-adrenergic agonists e.g nasal decongestant - calcium channel blockers e.g dihydropyridines (nifedipine) - antineoplastics e.g vincristine - anticholinergics e.g antihistamines
68
List 3 classes of medication that could cause urinary incontinence.
- alpha-adrenergic blockers e.g doxazosin (urethral relaxation) - sedatives e.g long acting benzodiazepines e.g diazepam - diuretics e.g furosemide, bumetanide
69
What are the 6 types of incontinence?
- stress - urge urinary - neurogenic urinary - mixed urinary - overflow - functional
70
What does it mean to have OAB? What does it cause?
involuntary contractions of the detrusor muscle - urinary urgency - urinary frequency - urinary nocturia
71
What does stress incontinence mean? What is it caused by?
when pressure (stress) on the bladder causes urine to leak - not related to psychological stress - involuntary leakage during activities that increase abdominal pressure caused by physical movements or activity such as coughing, laughing, sneezing, running or heavy lifting
72
Who is stress incontinence common in?
women after childbirth and menopause men post-prostate surgery
73
What is urge urinary incontinence? What is it often associated with? What can it be due to?
sudden and intense urge to urinate leading to involuntary loss of urine overactive bladder bladder inflammation, infection, or neurological conditions
74
What is the sudden and intense urge to urinate leading to involuntary loss of urine called?
urge urinary incontinence
75
What is the most common cause of urinary incontinence in the elderly?
urge urinary incontinence
76
What is neurogenic urinary incontinence? What can it be due to?
loss of bladder control or loss of feeling of fullness - nerve damage due to diabetes, alcoholism, vitb12 deficiency, pelvic surgery, genital herpes - brain or SC disease or injury - MND, spina bifida
77
What kind of incontinence can nerve damage cause?
neurogenic urinary incontinence
78
What is overflow incontinence?
79
What is functional incontinence?
80
What is mixed urinary incontinence?
81
What are some managements, treatments and preventions for incontinence?
82
What are some effective drugs for incontinence?
antimuscarinic drugs e.g axybutynin act on M3 receptors botulinum toxin resiniferatoxin and capsaicin (target sensory nerves).
83
An antimuscarinic drug for incontinence causes dry mouth and constipation. Name the drug and explain why.
axybutynin - targets m3 receptors and they are present in salivary glands and gut
84
What is a side effect of axybutynin?
dry mouth acts on m3 receptors which are also present in salivary glands and gut
85
List one positive and one negative on the use of botulism toxin for incontinence treatment.
very effective administration is difficult
86
As the urinary bladder fills, what normally happens to the detrusor pressure? Explain.
remains the same
87
Which muscle needs to contract and which muscle needs to relax to allow urinary bladder to empty?
detrusor contracts external sphincter relaxes
88
What are 'phasic contractions of the bladder'?
small involuntary contractions of the detrusor muscle that can occur even in the absence of a full bladder
89
What class of drugs should initially be prescribed for someone with urinary incontinence? If the patient could not tolerate swallowing tablets, what else could you prescribe?
anticholinergics transdermal oxybutynin hydrochloride
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