Bladder Flashcards
Where is the bladder?
- in the suprapubic area
- apex: can go as high as the umbilical when full
- body: between apex and fungus (base)
What is the function of the bladder?
- temporary storage of urine
- expulsion of urine (musculature contraction during micturition)
What is the clinical relevance of the bladder to spinal cord injuries?
- reflex bladder = transaction above t12 = afferent signals from bladder wall unable to reach brain = no awareness of bladder filling = no descending control over the external urethral sphincter (constantly relaxed)
- spinal reflex = parasympathetic systems initiates Detrusor contraction in response to bladder wall stretch = bladder empties at it fills
What terms is given to the clinical bladder condition below T12?
- flaccid bladder
- spinal cord transaction => damaged parasympathetic outflow to bladder
- detrusor myself paralysed => no spinal reflex
- bladder will fill uncontrollably => distends => overflows
Where do urinary tract infections (UTIs) affect?
- bladder (cystitis)
- urethra (urethritis)
- kidneys (kidney infection)
How are UTIs treated?
- antibiotics
What are the signs and symptoms of UTIs?
- pain or burning sensation when urinating (dysurie)
- urinating more often than usual during the night (nocturia)
- cloudy, dark + strong smelling urine
- urgent urination
- increased urination
- blood in urine
- lower abdominal pain or pain in back under ribs
- high temperature/feeling hot/shivery
- low temperature (below 36)
Why is temperature key for diagnosis of UTIs?
- temp below 36 degrees = clinical emergency = body shutting down (usually older patient)
What is normal body temperature?
- 37 degrees
How do children with UTIs present?
- high temperature
- appear generally well, maybe irritable and not feed or eat properly
- wet the bed
- vomit
How do older, frail people present with UTIs and a catheter present?
- agitation or confusion
- incontinence that is worse than usual
- shivering and shaking (new onset)
What are the causes of UTIs?
- bacteria from fecal matter entering urinary tract
What are the risks for UTIs?
- sex
- pregnancy
- blockages of the urinary tract e.g. kidney stones
- difficulties emptying bladder e.g. enlarged prostate (men) constipation (children)
- catheters
- weakened immunity
- not drinking enough fluids
- poor hygiene of genital area
- female => shorter urethra
- pregnancy => lowered immunity
What management can you offer patients with suspected UTIs?
- refer to GP for antibiotics + painkiller
- self-care advice
- urinate after sex
- drink fluids
What can ease symptoms of UTIs?
- paracetamol: 4x a day
- children = liquid paracetamol
- rest + drink fluids
- avoid sex
Long term UTIs are linked to an increase of what disease?
- bladder cancer in people over 60
What happens if UTI recurs within 6 months
- gp may prescribe a low-dose antibiotic for up to 6 months
- vaginal cream (oestrogen) for post-menopausal women
- refer to specialist for tests/treatment
Describe bladder cancer
- abnormal tissue growth (tumour) in bladder lining
- can spread to bladder muscle
What are the symptoms of bladder cancer?
- blood in urine, usually painless
If a patient has blood in their urine, what should you do?
- refer to GP
What are the common causes of haematuria?
- UTI
- kidney infection
- kidney stones
- urethritis
- enlarged prostate
What are the classifications of bladder cancer?
- non-muscle invasive bladder cancer = contained in lining of bladder
- muscle invasive bladder cancer = less common, higher chance of spreading
What are the signs and symptoms of Haematuria?
- frequent urination
- urge to urinate
- burning sensation when passing urine
- smell
What are the advanced signs of bladder cancer?
- pelvic pain
- bone pain
- unintentional weight loss
- swelling of the legs (bladder retains fluid)
What are the risk factors for bladder cancer?
- smoking
- dyes
- textiles
- rubbers
- paints
- plastics
- leather tanning
- taxi and bus drivers => exposure to chemicals present in diesel fumes
How is bladder cancer diagnosed?
- refer to GP
- MRI
- CT
- transurethral resection of bladder turmour (TURBT)
- cystoscopy
What is the staging and grading system for bladder cancer?
- staging = how far cancer has spread; lower stage => better chance of successful treatment
- grading = how likely cancer will spread; high grade => more likely to spread
What is the most widely used staging system for bladder cancer?
- T: tumour = how far into bladder it has grown
- N: nodes = has it spread to lymph nodes
- M: metastasis = spread to other body parts
What are the treatment options for bladder cancer?
- transurethral resection of bladder tumour (TURBT)
- chemotherapy
- cystectomy
- radiotherapy
What is the nervous supply to the bladder?
- autonomic (sympathetic + parasympathetic) + somatic
- sensory afferent nerves => signal for urination when bladder is full
Which sympathetic nerve supplies the bladder?
- hypogastric nerve T12-L1 => relaxation of detrusor muscle, promoting urine retention
Which parasympathetic nerve supplies the bladder?
- pelvic nerve S2-S4 => contraction of detrusor => micturition
Which somatic nerve supplies the bladder?
- pudendal nerve S2-S4 => external urethral sphincter => control over micturition
