Bladder

Question 1

Where is the bladder?

Answer 1

• in the suprapubic area
• apex: can go as high as the umbilical when full
• body: between apex and fungus (base)

Question 2

What is the function of the bladder?

Answer 2

• temporary storage of urine
• expulsion of urine (musculature contraction during micturition)

Question 3

What is the clinical relevance of the bladder to spinal cord injuries?

Answer 3

• 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

Question 4

What terms is given to the clinical bladder condition below T12?

Answer 4

• flaccid bladder
• spinal cord transaction => damaged parasympathetic outflow to bladder
• detrusor myself paralysed => no spinal reflex
• bladder will fill uncontrollably => distends => overflows

Question 5

Where do urinary tract infections (UTIs) affect?

Answer 5

• bladder (cystitis)
• urethra (urethritis)
• kidneys (kidney infection)

Question 6

How are UTIs treated?

Answer 6

• antibiotics

Question 7

What are the signs and symptoms of UTIs?

Answer 7

• 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)

Question 8

Why is temperature key for diagnosis of UTIs?

Answer 8

• temp below 36 degrees = clinical emergency = body shutting down (usually older patient)

Question 9

What is normal body temperature?

Answer 9

• 37 degrees

Question 10

How do children with UTIs present?

Answer 10

• high temperature
• appear generally well, maybe irritable and not feed or eat properly
• wet the bed
• vomit

Question 11

How do older, frail people present with UTIs and a catheter present?

Answer 11

• agitation or confusion
• incontinence that is worse than usual
• shivering and shaking (new onset)

Question 12

What are the causes of UTIs?

Answer 12

• bacteria from fecal matter entering urinary tract

Question 13

What are the risks for UTIs?

Answer 13

• 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

Question 14

What management can you offer patients with suspected UTIs?

Answer 14

• refer to GP for antibiotics + painkiller
• self-care advice
• urinate after sex
• drink fluids

Question 15

What can ease symptoms of UTIs?

Answer 15

• paracetamol: 4x a day
• children = liquid paracetamol
• rest + drink fluids
• avoid sex

Question 16

Long term UTIs are linked to an increase of what disease?

Answer 16

• bladder cancer in people over 60

Question 17

What happens if UTI recurs within 6 months

Answer 17

• 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

Question 18

Describe bladder cancer

Answer 18

• abnormal tissue growth (tumour) in bladder lining
• can spread to bladder muscle

Question 19

What are the symptoms of bladder cancer?

Answer 19

• blood in urine, usually painless

Question 20

If a patient has blood in their urine, what should you do?

Answer 20

• refer to GP

Question 21

What are the common causes of haematuria?

Answer 21

• UTI
• kidney infection
• kidney stones
• urethritis
• enlarged prostate

Question 22

What are the classifications of bladder cancer?

Answer 22

• non-muscle invasive bladder cancer = contained in lining of bladder
• muscle invasive bladder cancer = less common, higher chance of spreading

Question 23

What are the signs and symptoms of Haematuria?

Answer 23

• frequent urination
• urge to urinate
• burning sensation when passing urine
• smell

Question 24

What are the advanced signs of bladder cancer?

Answer 24

• pelvic pain
• bone pain
• unintentional weight loss
• swelling of the legs (bladder retains fluid)

Question 25

What are the risk factors for bladder cancer?

Answer 25

• smoking
• dyes
• textiles
• rubbers
• paints
• plastics
• leather tanning
• taxi and bus drivers => exposure to chemicals present in diesel fumes

Question 26

How is bladder cancer diagnosed?

Answer 26

• refer to GP
• MRI
• CT
• transurethral resection of bladder turmour (TURBT)
• cystoscopy

Question 27

What is the staging and grading system for bladder cancer?

Answer 27

• 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

Question 28

What is the most widely used staging system for bladder cancer?

Answer 28

• T: tumour = how far into bladder it has grown
• N: nodes = has it spread to lymph nodes
• M: metastasis = spread to other body parts

Question 29

What are the treatment options for bladder cancer?

Answer 29

• transurethral resection of bladder tumour (TURBT)
• chemotherapy
• cystectomy
• radiotherapy

Question 30

What is the nervous supply to the bladder?

Answer 30

• autonomic (sympathetic + parasympathetic) + somatic
• sensory afferent nerves => signal for urination when bladder is full

Question 31

Which sympathetic nerve supplies the bladder?

Answer 31

• hypogastric nerve T12-L1 => relaxation of detrusor muscle, promoting urine retention

Question 32

Which parasympathetic nerve supplies the bladder?

Answer 32

• pelvic nerve S2-S4 => contraction of detrusor => micturition

Question 33

Which somatic nerve supplies the bladder?

Answer 33

• pudendal nerve S2-S4 => external urethral sphincter => control over micturition