217b bladder dysfunction Flashcards
bladder compliance
changes volume without a change in P
highly compliant wall –> elastic and viscoelastic via innervation
what is found in bladders with poor compliance?
type III collagen
innervation of bladder
parasympatheric - pelvic nerve (craniosacral); S2-4; modulates bladder contractions to void
sym - hypogastric (thracolumbar); T10-L2; innervates bladder neck to stop leakage (also inhibits parasympathetics)
postgang are unmyelinated
external sphincter
pudenal nerve (s2-4) –> skeletal muscle
nerve bodies in Onuf’s nucleus
afferent bladder
back through pelvic, hypogastric and pudendal nerves to dorsal root ganlia
central coordination
pontine micturition center – barrington’s nucleus
coodrinates detrusors, sphincter
input from highter centers
cerebral cortex - allows control
bladder filing
sym stimulated - a contracts internal sphincter and b relaxes bladder
pudendeal nerve increases EUS tone
Parasympathetics inactive
voiding
EUS - inhibition of somatic activity
inhibit symp outflow
increase parasym outflow to bladder (contraction -ACh - muscarinic), urethra relax (NO)
cholinergic receptors in bladder, urethra
Muscarinic (M2) - bladder
Nicotinic - skeletal muscles
adrenergic receptors
NE, E
a - contraction - outlet
B- relaxation - bladder wall
OAD
urgency - loss of cortical inhibition
Rx - kegel exercise - inhibit bladder contraction
behavioral modification
anticholinergic medications
B meds
areflexia
absence of detrusor contraction –> catheder
no P change – muscle is relxed
detrusor overactivity
involuntary contraction wth bladder filling –> can lead to leakage
diminished compliance
increased detrusor P –> blocks urine delivary –> hydronephrosis and kidney dysfunction
detrussory sphincter dyssynergia
discoordination between bladder and sphincter
cervical or thoracic level spinal injury
