217- neurology and voiding dysfxn Flashcards
Sympathetic innervation of bladder:
parasympathetic innervation of bladder:
Somatic innervation of External urethral sphincter
arises T10-L2 and travels via hypogastric. In addition to alpha and beta receptors, also inhibits parasympathetics
Arises from S2-S4 and travel via pelvic
Arises from S2-S3 and travel via pudendal. nerve bodies on Onuf’s nucleus. Nicotinic receptors
Coordination center for micturition
Pontine micturition center. (barrington’s nucleus)
first neurologic change with voiding of bladder
relaxation of EUS then detrusor contraction which pulls open bladder neck
What happens when you have a neurologic lesion above the pons? are you worried about kidneys? Examples?
Loss of inhibition from cortex with intact coordination so no danger to kidneys because no increase in storage pressure. Stroke, alzheimers, tumor.
what happens in lesions below pons in supra sacral region? how do you diagnose? Can it damage kidneys? Treatment?
loss of coordination. Bladder urodynamic study. Can get bladder hyper reflexia and bladder-detrusor dyssynergia. Can damage kidneys. Treat with meds (anti-cholinergics, beta agonists), botox, surgical enlargement
lesion in sacral spinal cord effect? Can it damage kidneys? Treatment?
atonic bladder, inability to void volitionally. Won’t usually damage kidneys. Treat with catheter
cholinergic receptors: what releases ACh? What are the types of receptors and where are they?
Released from: all preganglionic autonomics, postganglionic parasympathetics, somatic neurons
Muscarinic Receptors: on all autonomic effector cells (bladder, sweat glands, bowel, CNS).
Nicotinic Receptors: on skeletal muscle endplates, in autonomic ganglia
what type of cholinergic receptors are there on the bladder?
muscarinic: M3 (20%) responsible for muscle contraction
M2 (80%) enhance response to M3 by inhibiting sympathetic suppression of detrusor contraction
initial effect of spinal cord injury
shock. May last for days- weeks. usually areflexia resulting in urinary retention so you catheterize