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Renal > Anatomy of urinary bladder, urethra and micturition > Flashcards

Anatomy of urinary bladder, urethra and micturition Flashcards

1
Q

How much urine triggers urinating

A

400-600ml

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2
Q

Name of superior wall of bladder

A

Bladder apex

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3
Q

What is the urethral sphincter?

A

Converge of bladder walls

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4
Q

How is detrusor muscle controlled?

A

Autonomic innervation (not voluntarily controlled)

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5
Q

What is the internal urethral sphincter?

A

Autonomically innervated, stops flow of urine into urethra to stop micturition

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6
Q

Where is the prostate in relation to urethra?

A

Surrounds it

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7
Q

Can we control external sphincter?

A

Yes it is striated

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8
Q

What is the trigone?

A

Smooth muscle where ureters enter

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9
Q

What makes the bladder wall tough?

A

Detrusor

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10
Q

What is the uracus?

A

In embryo takes urine to be excreted but normally disappears, leaving median umbilical ligament

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11
Q

Function of pubovesical ligament

A

From pubic bone, around bladder neck and back yo bone, holds neck rigid

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12
Q

Another name for pubovesical ligament in men

A

Puboprostatic ligament

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13
Q

What is transitional epithelium?

A

Cells in cube like structure, very organised, sits on lamina propria

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14
Q

What is the serosa?

A

Flexible fascia

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15
Q

Layers surrounding bladder, outwards to inwards

A 
Perivesical fat
Serosa
Detrusor muscle
Submucosa
Lamina propria
Transitional epithelium
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16
Q

How do ureters enter bladder?

A

Oblique fashion on posterior wall

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17
Q

Where is the perineum?

A

Pubic symphysis to coccyx

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18
Q

Which section of the pelvis is the bladder in?

A

Lesser

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19
Q

Where does the pelvis divide?

A

Pelvis inlet - bordered by sacrum and pubic bones

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20
Q

Function of medial umbilical ligament

A

Inserts into anterior abdominal wall, makes bladder tetrahedral

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21
Q

Two pouches in females

A

Recto-uterine and utero-vosica;

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22
Q

What is the sigmoid colon?

A

Large bowel that enters rectum

23
Q

Why is the lesser pelvis shaped like a funnel?

A

Levator ani

24
Q

What is the perineal membrane

A

Runs in anterior perineum between ischial tuberosities and pubic bone - halfway between perineal layers

25
Q

Layers of perineal

A 
Deep pouch
Perineal membrane
Superficial pouch
Deep fascia
Superficial fascia
26
Q

Where does the aorta divide and what does it form

A

L4, forms common iliac arteries

27
Q

Which artery supplies pelvis?

A

Internal iliac

28
Q

Blood supply to bladder

A

Aorta - common iliac - internal iliac - vesical arteries

29
Q

Venous drainage of bladder

A

Vesical venous plexus
Drains to internal iliac vein at multiple points
Continuous with prostate/vaginal plexus

30
Q

Lymph drainage of bladder

A
  • Deep abdominal and pelvic organs drain to lymph nodes around arteries
  • Superficial channels - lymph nodes around major veins
  • Bladder drains to internal, external iliac arteries
31
Q

Which plexus helps with micturition

A

Inferior hypogastric

32
Q

How do p/s neurones reach plexus

A

Pelvic splanchnic nerves

33
Q

How do sympathetic neurones reach plexus

A

Sacral splanchnic nerves

34
Q

Function of pudendal nerve

A

S2,3, innervates external urethral sphincter for voluntary contraction and inhibits micturition

35
Q

Which neurones inhibit micturition

A

Sympathetic

36
Q

Function of trigone in micturition

A

Stimulates visceral afferent nerves

37
Q

Where is the micturition centre

A

Pons

38
Q

What happens to bladder at rest?

A

At rest, visceral afferent nerves stimulate sacral splanchnic nerves to inferior hypogastric plexus - runs to detrusor muscle to relax it - internal urethral sphincter contracts to stop urine reaching urethra

39
Q

Spinal nerves parasympathetic - pelvic splanchnic nerves and inferior hypogastric plexus

A

S2-4

40
Q

Spinal nerves sympathetic - pelvic splanchnic nerves and inferior hypogastric plexus

A

T11-L2

41
Q

How does the urethra reach skin?

A 
Anterior aperture of elevator ani
Enters deep perineal pouch 
Enters superficial pouch
In F enters vestibule
In M enters glans
42
Q

Where is external urethral sphincter?

A

Deep pouch

43
Q

What is cystitis

A

Irritation of bladder wall

44
Q

Why are females more susceptible to UTIs

A

Urethra is only 4cm long

45
Q

What are Skene’s glands?

A

Mucous glands wither side of urethra - homologous to prostate

46
Q

How is the urethra divided in men?

A

preprostatic, prostatic (dilatable, receives ejaculatory ducts), membranous (narrow, surrounded by external sphincter - catheters get resistance here), penile (receives bulbourethral glands, ends as navicular fossa)

47
Q

How does epithelium change along urethra?

A

transitional at beginning, then most is pseudostratified columnar, then stratified squamous (skin

48
Q

Which muscles help to clear urine from urethra?

A

Bulbospongiosus in M

Bulbocavernous in F

49
Q

Blood supply to urethra

A

M: P: Inferior vesical
M: bulbourethral (from inf vesical)
P: interior pudendal

F: mix of vesical/vaginal/pudendal arteries

50
Q

Nervous supply of urethra

A

M: prostatic plexus, pudendal nerve
F: vesical plexus, pudendal nerve

51
Q

Lymph drainage of urethra

A

M: anterior drains to inguinal lymph nodes, posterior to iliac lymph nodes
F: iliac nodes

52
Q

Where is the narrowest part of the urethra in men?

A

Membranous

53
Q

Where will a catheter encounter resistance in men?

A

Prepubic angle

Infrapubic angle

54
Q

Suprapubic catheter

A
  • Ultrasound to verify full bladder
  • Abdominal skin prepared and lidocaine injected into 2 centimetres above symphysis pubis
  • Risks: bowel perforation, bleeding, infection, enterovesical fistula
  • Indications: urethral injury, absolute urethral obstruction, long-term catheterisation
  • Method: direct puncture (mushroom catheter straightened with stylet and advanced into bladder, once catheter is confirmed within bladder, stylet removed) and seldinger technique (needle is inserted until urine aspirated, guidewire placed through needle into bladder and needle removed, dilator advanced over wire enlarging the tract. Dilator replaced with sheath, guidewire removed and catheter placed through sheath, which is peeled away. Balloon is inflated and catheter with drawn until tension felt, catheter connected to drainage system and secured)

Renal (26 decks)

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