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REB > 28. Urinary Bladder and Micturition > Flashcards

28. Urinary Bladder and Micturition Flashcards

1
Q

What is the innervation of the ureters?

A

Autonomic NS

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2
Q

What type of epithelium is found in the ureters?

A

Transitional, allows for stretch

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3
Q

What is the function of the oblique path of the ureters against the bladder wall?

A

Creates a valve
Tone of detrusor muscle keeps the ureter compressed
Reduces urinary reflux and damage

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4
Q

What causes urine to flow from renal calices?

A

Calices stretched from vol of urine
Stimulates inherent pacemaker activity
Initiates peristalsis

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5
Q

What is the ureterorenal reflex?

A

Blockage of the ureter causes build up of urine above the block and pain
Reflex activation of sympathetics to the afferent arteriole
Decreases urine output

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6
Q

What is hydronephrosis?

A

Swelling of kidney due to build-up of urine

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7
Q

Why does an increase in urine volume not cause a change in pressure in the bladder up to a certain point?

A

Transitional epithelium allows for stretch
Rugae
Plasticity of smooth muscle
>increased tension increases radius and they remain proportionate: obey law of la place

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8
Q

At what volume of urine do we have an awareness of a need to void?

A

150ml

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9
Q

At what volume of urine do we have an urge to void?

A

300ml

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10
Q

At what volume of urine do we experience pain?

A

600ml

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11
Q

What are the origins of the sympathetic nerves to the bladder?

A

T10-L4

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12
Q

What nerves give sympathetic innervation to the bladder?

A

Hypogastric

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13
Q

What receptors do the hypogastric nerves act on?

A

B3 relaxes detrusor muscle

a1 tightens internal sphincter

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14
Q

What NT is used in the hypogastric nerves?

A

NA

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15
Q

What are the origins of the parasympathetic nerves to the bladder?

A

S2-S4

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16
Q

What nerves give parasympathetic innervation to the bladder?

A

Pelvic plexus

17
Q

What NT is used in the pelvic plexus?

A

ACh

NO

18
Q

What receptors does the pelvic plexus act on?

A

Muscarinic M3 ACh
Contracts detrusor
Relaxes internal sphincter

19
Q

What are the origins of the somatic nerves to the bladder?

A

S2-4

20
Q

What nerve gives somatic innervation to the bladder?

A

Pudendal

21
Q

What NT is used in the pudendal nerve?

A

ACh

22
Q

What receptors does the pudendal nerve act on?

A

Nicotinic ACh

Contracts external sphincter

23
Q

What happens in the storage phase?

A

Low firing from stretch receptors in the bladder
Signals to spinal cord
Inhibit parasympathetic activity: relax detrusor muscle and contracts internal sphincter
Signals set to midbrain (pontine storage centre) to increase external urethral activity and decrease parasympathetic activity

24
Q

What happens in the voiding phase?

A

Relaxation of urethral sphincters
Contraction of detrusor muscle
Increased bladder pressure
Valsalva manoeuvre

25
Q

Where does increased firing of bladder afferents go to?

A

Rostal brain stem

26
Q

Where does stretch info from the bladder get processed?

A

Periaqueductal Gray and Pontine micturition centre

-gives sensation of bladder fullness

27
Q

What are the 2 stages of loss of voluntary micturition control after a spinal cord injury?

A

Areflexic

Hyperreflexic

28
Q

What happens during the areflexic stage?

A

Atonic bladder
Spinal cord is isolated from the brain and can’t sense full bladder
Reflexes are absent below the level of the lesion
Bladder loses tone and will leak uncontrollably

29
Q

What is the treatment for someone with atonic bladder?

A

Catheterisation

Prevents stretching and damage to bladder

30
Q

What happens during the hyperreflexic phase?

A

Automatic bladder
Reflexes in sacral region of spinal cord are isolated from brain
Bladder empties automatically when full due to spinal reflexes

31
Q

How can a patient with an automatic bladder control micturition?

A

Press on abdomen to initiate the reflex at an appropriate time

REB (29 decks)

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