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3 REN > 17 control of bladder emptying > Flashcards

17 control of bladder emptying Flashcards

1
Q

What pushes urine down the ureter?

A

peristaltic waves from atypical smooth muscle cells

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2
Q

What are the 2 types of kidney stones?

A

nephrolithiasis

ureterolithiasis

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3
Q

name 2 treatments for kidney stones

A

percutaneous nephrostomy

extracorporeal shock wave lithotripsy

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4
Q

What would a bladder empty state of over 100ml suggest?

A

significant urinary retention

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5
Q

What alterations might be made to urine in the lower urinary tract?

A

singalling molecules

cells…

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6
Q

What are the layers to the bladder wall?

A

urothelium
lamina propria
detrusor smooth muscle
serosa

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7
Q

What are the adaptations of the urethlium surface?

A

tight junctions

umbrella cells

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8
Q

What are the contents of the lamina propria?

A 
blood vessels
lymphatics
nerves
interstitial cells of Cajal
connective tissue
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9
Q

What is the role of the interstitial cells of Cajal?

A

mediate communication between urothelium and detrusor

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10
Q

What is the arrangement of detrusor muscle?

A

smooth muscle bundles
basket weave

continuous with urethra

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11
Q

What does ParaSNS stimulate in the detrusor?

A

ACh : M3 -> contraction

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12
Q

What does SNS sitmulate in the detrusor?

A

NAd : B3 -> relaxation

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13
Q

What receptor in detrusor is often targeted pharmacologically, and why?

A

Beta-3 adrenoreceptor

it is specific to the bladder

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14
Q

How is signalling coordinated to the detrusor muscle fibres?

A

synchronous activity of ParaNS neurones

gap junctions

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15
Q

What about detrusor changes down to the urethra?

A

its’ behaviour

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16
Q

What are the layers of muscle in the bladder + urethra?

A

inner layer SM

outer layer somatic - skeletal

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17
Q

What is the role of the somatic system in urinary continence?

A

active

keeps striated sphincter contracted

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18
Q

What is the role of the sympathetic system in urinary continence?

A

active
constricts SM sphincters
keeps storage element relaxed

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19
Q

What is the role of the parasympathetic system in urinary continence?

A

inactive

20
Q

What is the role of the somatic system in urinary voiding?

A

inactive

21
Q

What is the role of the sympathetic system in urinary voiding?

A

inactive

22
Q

What is the role of the parasympathetic system in urinary voiding?

A

active

storage element walls contract

23
Q

What higher centres are involved in the voiding reflex?

A

peri-aqueductal grey matter

pontine micturition centre

24
Q

What does stimulation of the voiding reflex do?

A

inhibits somatic outflow
relaxes EUS

switches off symp relexation
switches on para, bladder contraction

25
Q

How can you measure urethral and intravesical pressure?

A

catheter

26
Q

How can you measure urethral EMG?

A

stick an electrode through the anterior wall of the anus for men

yeah, i know

27
Q

What needs to occur before the bladder wall contracts?

A

EUS relaxes

urethral pressure falls

28
Q

What 6 problems might cause urinary incontinence?

A 
UTI
spinal cord disorder
stroke
pelvic floor injury
atonic bladder
29
Q

How does a UTI cause urinary incontinence?

A

chemical stimuli increase bladder activity and hence urge to void

30
Q

What spinal cord disorders may cause urinary incontinence?

A

injury

MS

31
Q

Why might you get detrusor overactivity?

A

with age, as a response to prostate enlargement

prostate enlargement increases resistance to flow

32
Q

What is atonic bladder secondary to?

A

autonomic neuropathy

33
Q

What happens in atonic bladder?

A

bladder fills, pressure rises sufficiently to leak

incontinence - small volume, high frequency urination

34
Q

How might women get stress incontinence?

A

increase in pressure forces back the posterior wall of the urethra

normally this would be prevented by the anterior wall of the vagina, although this can be weakened

35
Q

What 3 surgical techniques may be used to treat stress incontinence?

A

synthetic mid-urethral tape
open colposuppression
autologous rectus fascial sling

36
Q

What group of drugs might you use to treat stress incontinence?

A

over-active bladder drugs

OAB drugs

37
Q

What are the 3 main types of OAB drugs?

A

anti-muscarinic drugs
botulinum toxin
beta-3 adrenoreceptor agonists

38
Q

Name an antimuscarinic drug

A

oxybutynin

39
Q

Name a beat-3 adrenoreceptor agonist

A

mirabegron

40
Q

Whta OAB drugs might target sensory neurones?

A

resiniferatoxin

capsaicin

41
Q

What OAB experimental drugs are there?

A

PDE-5 inhibitors

K+ channel activators

42
Q

What 3 drugs are first-line treatment to women with OAB or UTI?

A

Oxybutynin
Tolterodine
Darifenacin

43
Q

What might cause urinary outflow obstruction?

A

prostomegaly (BPH)

urethral sphincter

44
Q

What surgical technique might you use to treat urinary outflow obstruction?

A

transurethral resection of the prostate

TURP

45
Q

What medical techniques might you use to treat urinary outflow obstruction

A

alpha-adrenoreceptor antagonists

5-alpha-reductase inhibitors

46
Q

How might alpha-adrenoreceptor antagonists treat urinary outflow obstruction?

name 2 examples

A

relax prostate SM

terazosin
tamsulosin

47
Q

How might 5-alpha-reductase inhibitors treat urinary outflow obstruction?

name 1 example

A

reduce hypertrophy

finasteride

3 REN (21 decks)

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