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Renal Exam 1 > (4) Micturition (SD Wang) > Flashcards

(4) Micturition (SD Wang) Flashcards

1
Q

What is micturition?

A

How your body gets rid of urine!

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2
Q

What is considered the upper urinary tract?

What is the considered the lower urinary tract?

A

Upper urinary tract = Kidney & Ureter

Lower urinary tract = Bladder, Urethra

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3
Q

State what type of muscle lines each sphincter

Internal Urethral Sphincter

External Urethral Sphincter

A

Internal Urethral Sphincter = Smooth muscle

External Urethral Sphincter = Skeletal muscle

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4
Q

What are the three demarcations of the trigone?

A

(2) Urethral openings
(1) Internal urethral sphincter

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5
Q

Function of the trigone?

A

Senses “fullness” of the bladder

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6
Q

Clinical Correlations:

Blockade of Urethral Outflow

Caused by?

What results?

A

Caused by= blockage in ureter

What results= increase in hydrostatic pressure, ureteral dilation, hydronephrosis

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7
Q

Clinical Correlations:

Anatomic Constrictions

Where can this occur?

A

Where can this occur =

  1. Ureteropelvic junction
  2. testicular/ovarian a./v.
  3. external iliac a./v.
  4. bladder wall
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8
Q

Clinical Correlations

Vesicoureteral Refulx

What is occuring?

A

Ureteral openings don’t fully close…

Leading to urine traveling back up the ureter

*Increased risk of pyelonephritis (kidney infection)

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9
Q

Describe the pathway for afferent (sensory) system of the bladder

A

Intravesical pressure stretch signals –>

Sensory nerve fibers (run w/ pelvic splanchnic n. and hypogastric plexus) –>

S2-S4 (sacral micturrition center)

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10
Q

What fibers transmit bladder fullness signals to the brain?

A

A (delta) fibers - myelinated

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11
Q

What fibers transmit bladder pain signals to the brain?

A

C fibers (unmyelinated)

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12
Q

Describe the efferent (motor)

PARASYMPATHETIC

What spinal level?

What nerve?

What does activation of this nerve this cause?

Neurotransmitter?

Receptor?

A

S2-S4

Pelvic splanchnic n.

Contraction of the detrusor m. and internal sphincter relaxation

ACh

mAChR (M3)

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13
Q

Describe the efferent (motor)

SYMPATHETIC

What spinal level?

What nerve?

What does activation of this nerve this cause?

Neurotransmitter?

Receptor?

A

L2

Hypograsteric n.

Detrusor m. relaxation and internal sphincter contraction

NE

Adrenergic

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14
Q

Describe the efferent (motor)

SOMATIC

What spinal level?

What nerve?

What does activation of this nerve this cause?

Neurotransmitter?

Receptor?

A

S2-S4

Pudendal n.

External urethral sphincter contraction

ACh

nAChR

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15
Q

What are the two bladder reflexes?

A
  1. Storage reflex
  2. Voiding reflex
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16
Q

The storage reflex is initiated in the _________

A

Spinal Cord

17
Q

What is the storage reflex activated by?

Which causes?

Which then results in…

A

Bladder filling

Causes sympathethetic and somatic outflow

Detrusor m. relaxed & external sphnicter contracter

18
Q

What is the Voiding Reflex activated by?

Which causes?

Which then results in…

A

Full bladder

Afferent neurons to transmit to spinal cord, then brain

Stimulates parasympathetic outflow and inhibits sympathetic/somatic outflow

Detrusor m. contracting and external sphincter relaxing

19
Q

Where is the voiding reflex primarily occuring?

A

Brain

20
Q

Function of the cerebral cortex with bladder reflexes?

A

Interprets sensation

Can partially inhibit micturition reflex

21
Q

Function of the midbrain with bladder reflexes?

A

Contains the periaqueductal gray (PAG)

Receives afferent bladder signals

Primary excitation input to the PMC

Higher brain centers can suppress or stimulate the input of PAG to the PMC

22
Q

Function of the pons with bladder reflexes?

A

Contains the central hub of bladder reflexes “pontine micturition center (PMC)”

aka Barrington’s nucleus

Receives signals from the PAG and higher brain centers

Activates external sphincter relax and sacral parasym. outflow to cause micturition

Controls/coordinates S2-S4

23
Q
A

D. Pain is paroxysmal

Paroxysmal = intermittent

24
Q
A

B. Hydronephrosis

25
Q
A

C. Adrenergic receptor antagonist

26
Q
A

A. L2 Hypogastric nerves

27
Q
A

A. Detrusor m. contraction and internal sphincter relaxation

28
Q
A

C. Vesicoureteral reflux

29
Q
A

A. Detrusor m. and sphincter working in coordination

30
Q
A

C. Cerebral cortex

31
Q
A

B. Metastasis to sacrum

32
Q
A

C. Sympathetic pathway

33
Q
A

A. Urinary frequency

34
Q
A

C. Pudendal nerve, voluntary

Renal Exam 1 (8 decks)

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