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Renal and Urology > anatomy lecture 3; urinary continence > Flashcards

anatomy lecture 3; urinary continence Flashcards

1
Q

normal renal system motor function

A
  • ureteric peristalsis
  • bladder contraction
  • urethral sphincter control (internal and external urethral sphincter)
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2
Q

renal system pain

A 
pain from kidneys
pain from ureters
pain from bladder
pain from urethra 
pain from testes (not technically part of the renal system)
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3
Q

urinary continence

A

involves both motor and sensory innervation

- voluntary control of the elimination of urine from the bladder

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4
Q

lumbar and sacral plexus supplies

A

motorand sensory innervation to the perineum and the low limbs

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5
Q

how many modalities of nerve fibres are there

A

5

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6
Q

SENOSRY NERVE FIBRES

A
  1. Sensations from the body wall (soma) i.e. our external environment are conveyed to the CNS via somatic sensory nerve fibres
  2. Sensations from our visceral organs i.e. our internal environment are conveyed to the CNS via visceral afferent nerve fibres
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7
Q

MOTOR NERVE FIBRES

A
  1. Motor responses to our body wall (soma) i.e. our external environment are conveyed from the CNS by somatic motor nerve fibres which stimulates skeletal muscle (voluntary) to contract
  2. Motor responses to our organs i.e. our internal environment are conveyed from the CNS to sympathetic or parasympathetic nerve fibres
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8
Q

nerve modalities involved with normal renal system motor function

A
  • ureteric peristalsis and bladder contraction= sympathetic and parasympathetic nerve fibres
  • urethral sphincter control=
    1. internal urethral sphinctor= sympathetic and parasympathetic
    2. external urethral sphincter and the lavatory ani muscle - somatic motor
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9
Q

nerve modalities involved wth renal system pain

A
  • pain from the kidneys= visceral afferent
  • pain from the ureters= visceral afferent
  • pain from the bladder= visceral afferent
  • pain from the urethra= visceral afferent when in the pelvis but somatic sensory in the perineum
  • pain from the testes= visceral afferent
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10
Q

nerve modalities involved with urinary continence

A

voluntary excretion of urine from the bladder which involves sympathetic, parasympathetic, visceral afferent and somatic motor nerve fibres

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11
Q

nerve modalities involved with lumbar and sacral plexus

A

supplies sensory and motor innervation to the perineum and lower limb involves somatic sensory and somatic motor nerve fibres

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12
Q

The only means by which any type of nerve fibre can communicate with the CNS

A

is by being carried within either cranial nerve or spinal nerves

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13
Q

the distance that each type of nerve fibre is carried within a cranial nerve or spinal nerve will differ ie

A
  • somatic motor and somatic sensory nerve fibres are carried their entire length within cranial or spinal nerve
  • visceral afferents, sympathetic and parasympathetics only use the cranial and spinal nerves for limited portions to get into and out of the CNS
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14
Q

sympathetic nerve fibres leave the CNS

A

ONLY with spinal nerves T1-L2 (thoracolumbar outflow)

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15
Q

sympathetic fibres reach

A

smooth muscle/glands of the body wall (other than the head) within the spinal nerves (sympathetic fibres leaving the sympathetic chains and enter each pain of the 31 pairs of spinal nerves)

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16
Q

sympathetic nerve fibres reach the smooth muscle/ glands of the head mainly by

A

hitching a ride with arteries which supply the same structure

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17
Q

spina nerves contain

A

somatic sensory, somatic motor and sympathetic nerve fibres which innervate the smooth muscle and glands of the body wall

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18
Q

how do sympathetic nerve fibres get from the CNS to the kidneys ureter and bladder

A
  1. Sympathetic nerve fibres leave the spinal cord between the levels of T10-L2
  2. Enter sympathetic chains bilaterally but do NOT synapse
  3. leaves the sympathetic chains with abdominopelvic splanchnic nerves
  4. synapses at the abdominal sympathetic ganglia which are located around the abdominal aorta
  5. post-synaptic nerve fibres pass from the ganglia onto the surface of the arteries which rehearing towards the organs they need to innervate
  6. The collection of nerve fibres found on the outside of arteries is called a peri-arterial plexus
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19
Q

which other nerve fibre types also take part in such the peri-arterial plexus

A

parasympathetic and visceral afferent nerve fibres (as they are all going to and going from the same organs)

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20
Q

parasympathetic motor fibres of the autonomic nervous system leave he CNS

A

with cranial nerves 3,7,9 or 10 and the sacral spina nerves (crania-sacral outflow)

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21
Q

parasympathetic nerve fibres do NOT innervate what

A

smooth muscle or glands of the body wall,

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22
Q

parasympathetic nerve fibres reach the smooth muscle/ glands of the head and body via

A

cranial nerves

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23
Q

parasympathetic fibres reach the smooth muscle/ glands of the hindgut and pelvic organs

A

via pelvic splanchnic nerves

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24
Q

parasympathetic innervation to the kidneys

A

is carried within the vagus nerve

25
Q

parasympathetic innervation to the ureters

A

is carried within the vagus nerve

26
Q

parasympathetic innervation to the bladder

A

is carried within the pelvic splanchnic nerves which leave spinal nerves S2,S3, S4

27
Q

How do somatic motor nerve fibres get from the CNS to the kidneys, ureters and bladder

A

THEY DONT LAUGH OUT LOUD somatic fibres only go to body wall structures, only part of the renal system which somatic fibres go to are those within the perineum= distal perineum, external urethral sphincter and levaotr ani muscle

28
Q

Pain from the kidney (hydroneohrosis)

A

is felt in the loin region i.e. the posterior aspect of the flank region

29
Q

pain from a calculus obstructing the ureter

A

is felt radiating from the loin to groin region

30
Q

pain from the bladder is usually felt in

A

the supra-pubic region

31
Q

pain from the perineal part of the urethra is felt

A

localised in the perineum

32
Q

how do visceral afferent nerve fibres get from the kidney to the CNS

A
  • VISCERAL AFFERENT FROM THE KIDNEY run alongside sympathetic fibres back to the spinal cord
  • enters the spinal cord between the levels of T11-L1
    Hence patient feels pain in the dermatomes posteriorly hence the loin pain
33
Q

loin pain differential diagnosis

A

herepes zoster, muscular, vertebrae, spinal nerve root compression, lower lobe pneumonia

34
Q

how do visceral afferent nerve fibres get from the ureters to the CNS

A

visceral afferent erve fibres from the uretes run alongside sympathetic nerve fibres back to the spinal cord

  • enters the spinal cord between the levels of T11-L2
  • pain can be perceived anywhere along this path hence the radiation from loin to groin
35
Q

differential diagnosis of groin pain

A

hernias, testicular pathology, lymphadenopathy

36
Q

how do visceral afferent nerve fibres get from bladder to CNS

A
  • visceral afferent nerve fibres carrying pain from th part of the bladder which touches the peritoneum (superior part) runs alongside sympathetic chains and enters the spinal cord between the levels of T11-L2 and the pain is perceived in the supra-pubic region
  • visceral afferent fibres form the rest of the bladder rung alongside parasympathetic nerve fibres and enter the spinal cord at S2,3,4,
37
Q

Differential diagnosis of supra-pubic pain

A

handgun organs (sigmoid colon, diverticulum), other single midline pelvis organs who’s superior arts touch there peritoneum (i.e. the uterus)

38
Q

how do visceral afferent nerve fibres get form the urethra to the CNS

A
  • visceral afferent fibres from the proximal urethra run alongside parasympathetic nerve fibres back to the spinal cord at the levsk of S2,3,4
  • from the remaining urethra somatic sensory nerve fibres are carried within the pudendal nerve to S2,3,4, spinal nerves
  • pain is felt localied in the perineal area
39
Q

differential diagnosis of perineal pain

A

vagianl tear anal canal fissure, primal genital warts

40
Q

how do pain fibbers get from the tests to the CNS

A
  • DUE TO ITS embryological descent visceral afferent rung alongside sympathetic fibres back to spinal nerves T10-T11
  • however, due to its close relations to the scortal wall testilcualr pathology can cause pain localised int eh scrotum or groin pain via L1
41
Q

HOW DO WE CONTROL URINE FLOW: KEY NERVE FIBRES

A

nerve fibres entering leaving spinal cord levels S2-S4 ARE KEY TO CONTROL OF MICTURITION

42
Q

PELVIC SPLANCHNIC NERVES CARRY

A

Parasympathetic fibres which have left the CNS WITH S2,S3,S4

43
Q

Visceral afferent fibres

A

enter spinal cord at levels of S2-S4

44
Q

PUDENDAL NERVE

A

formed by s2,3,4, but carries somatic motor fibres

45
Q

micturition 1

A

as the bladder fills with urine it is sensed by stretch receptors at the end of visceral afferent nerve fibres

46
Q

micturition 2

A

this information is relayed to the CNS via S2,3,4, spinal cord levels

47
Q

micturition 3

A

there is a reflex at this point which empires the bladder by causing the detrusor muscles to contract (and inhibits the internal urethral sphincter in males)

48
Q

micturition 4

A

however, after being toilet trained this reflex can be overridden, action potential within inhibitory nerve fibres for the cortex travels inferiorly and inhibits the reflex and there can also be voluntary contraction of the external urethra splintor and the levaotr ani muscle

49
Q

once it is deemed appropriate to micturate

A

the inhibition of the reflex is is lifted and there is co-ordinated contraction/ relaxation of various muscles

  • detrusor muscle contracts (parasympathetic)
  • internal urethral sphincter in males relaxes parasympathetic
  • external urethral sphincot and the lavatory ani muscles relax
  • anteroom-lateral abdominal wall muscles contract to increase intra-abdominal pressure and force urine out of the external urethral orifice (somatic motor fibres)
50
Q

anterior rami of spinal nerves can form

A

plexus from which named nerves arise

51
Q

names nerves contain

A

somatic sensory, somatic motor and sympathetic nerve fibres going to and from body wall structures

52
Q

pudendal nerve

A

arises form sacral plexus and is formed from S2,3,4

53
Q

sciatic nerve

A

arises from the sacral plexus and is formed form L4-S3

54
Q

LUMABR PLEXUS GIVES RISE TO THE

A

NAMED NERVES THAT SUPLY THE LOWER LIMB

  • iliohypogastric (L1)
  • Ilioinguinal (L1)
  • LATERAL CUTANEOUS NERVE OF THE THIGH (L2,L3)
  • genito femoral nerve (L1,L2)
  • femoral nerve (L2-L4)
  • obruator nerve (L2-L4)
55
Q

ureteric peristalsis is

A

thought to be an automatic initiation by ureteric cells which have their own built in auto-rhythmicity

56
Q

bladder contract

A

parasympathetic fibres from S2,3,3 via pelvis splanchnic nerves stimulate the detrusor muscle to contract

57
Q

CONTROL OF THE INTERNAL URETHAL SPHINCTER

A

SYMPATHETIC FIBRES CAUSE IT TO CONTRACT (THIS OCCURS DURING EJACULATION)
PARASYMAPTHETIC FIBRES CAUSE IT TO RELAX

58
Q

external urethral sphincter and lavotr ani muscle

A
  • somatic motor fibres within the pudendal nerve cause the external urethral sphincter to contact, somatic motor fibres within the nerve to the levator ani muscle cause the lavator ani muscle to contract

Renal and Urology (51 decks)

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