case 8 - pbl Flashcards
what are the two main parts of the smooth muscle bladder chamber
the body
the neck
what happens in the body
this is where the urine collects
what are features of the neck
funnel shaped and connects with the urethra
what is the smooth muscle of the bladder called
the detrusor muscle
what is on the posterior wall of the bladder
the trigone
what is the trigone mucosa like
mucosa of this is smooth and is folded into rugae
where do the two ureters enter the bladder
at the uppermost angles of the trigone
name features of the internal sphincter
smooth muscle
involuntary control
parasympathetic
name features of the external sphincter
skeletal muscle
voluntary muscle
somatic innervation
what is normal urine flow
20-50mls
what is the layout of the urinary tract
the kidneys produce urine, the ureters connect the kidney to the bladder, where urine is stored and the urethra is the exit passage way from the bladder
what is the prostate
a compound tubuloalveolar exocrine gland
what does the prostate secrete
a slightly alkaline fluid that constitutes 30% of the semen volume
what does the prostate help to do
neutralise the acidity of the vaginal tract and prolongs the lifespan of the sperm
what are the four zones of the prostate
Transition zone
Peripheral zone - 70% of the gland
Central zone
Fibromuscular zone
what happens during ejaculation
during ejaculation, sperm is transmitted from the ductus deferent into the make urethra via ejaculatory ducts, which lie within the prostate gland
what is PSA excreted from
the prostaste
what converts testosterone to DHT
type 5 alpha - reductase
what does DHT cause
cell growth and inhibits apoptosis
is testosterone or DHT more potent
DHT
what are the two main steps of mictruition
The bladder fills until the tension in its walls rises above the threshold level
Elicits a nervous reflex - mictrurition reflex that empties the bladder
where does the urine flow from after the collecting ducts
the renal calyces, thus stretching them
what does the stretching of these calyces do
This increases pacemaker activity, which in turn initiates peristaltic contractions that spread to the renal pelvis and then downward along the length of the ureter. This forces urine from the renal pelvis to the bladder
what are peristaltic contractions of the ureter enhanced by
Peristaltic contractions in the ureter are enhanced by parasympathetic stimulation and inhibited by sympathetic stimulation
what is the name of the reflux when the contraction of the bladder does not lead to complete occulsion of the ureter
- urine is propelled backward into the ureter - vesicoureteral reflux
what does this cause
renal dysfunction
explain and describe the micturition reflex
as the bladder fills, sensory stretch receptors in the wall, initiate a stretch reflex
Sensory signals are conducted to the scarab plexus through sensory afferents of the pelvic splanchnic nerves and then reflexively back to the baller through the motor efferent fibres of the same splanchnic nerves
When bladder is only partially filled, the contractions usually relax and pressure falls to baseline
As it continues to fill, reflexes become more frequent and cause greater contractions of the detrusor muscle
This reflex is self-regenerative
Causes another reflex to pass through the pudendal nerves to the external sphincter to inhibit it
what happens in BPH
the small glands, muscle fibres and connective tissue all enlarge
what is the first change seen in BPH
the proliferation of the glandular tissue in the transitional zone
what is an important factor in causing BPH
the impairment of apoptosis
what happens when epithelial cells multiply excessively
they release an excessive amount of PSA into circulation
what is BPH mainly due to
impairment of apoptosis
what does this result in
accumulation of senescent cells in the prostate
what can androgens such as DHT do
can not only increase proliferation but inhibit cell death
what cells are responsible for androgen-dependent prostatic growth and why
Stromal cells are responsible for androgen-dependent prostatic growth because the type 2 5alpha reductase enzyme is only found in the stromal cells
what is hydronephrosis
is the dilation of the renal pelvis associated with progressive atrophy in the kidney due to obstruction to the outflow of urine
describe the pathology of prostate cancer
growth and multiplication of cells escape from normal control
Impairment of apoptosis due to mutation of p53
Occurs in the peripheral zone of the prostate
Invades stroma
what is the epidemiology of prostate cancer
prostatic carcinoma accounts for 7% of cancer in men
6th most common in the world
histologically, what kind of cancer is prostate cancer
adenocarcinoma
what is the gene associated with prostate cancer
BRCA I and II
what are the features of PSA testing
Interpreted with caution as natural increase in age and with prostatitis
Dilemma about screening methods as can lead to over-diagnosing patients who don’t require treatment
what is the mechanism of action of tamsulosin
Competitive inhibition for binding site of the alpha1 adrenergic receptors
Causes prostate smooth muscle relaxation
Reduces urethral occlusion
Quick acting
May cause a sudden drop in BP - dizziness
what is the mechanism of action of finasteride
blocks the enzyme 5 alpha reductase type 2
Slows conversion of testosterone to DHT - slowing down growth of stromal and epithelial cells
Promotes apoptosis
Slow acting
what is transurethral resection of the prostate
- gold standard in reducing symptoms, improving flow rates and decreasing post-voiding residual urine
Removes parts or all of the prostate
Loss of ability to ejaculate
what is inclusion health
Inclusion health is an umbrella term used to describe people who are socially excluded, who typically experience multiple overlapping risk factors for poor health, such as poverty, violence and complex trauma.
what services on the NHS are available to asylum seekers
In Scotland and Wales they are entitled to free secondary health care
In England they are only offered free secondary health care if they receive section 4;2 support from the home office
when can asylum seekers begin to work
People who have claimed asylum in the UK can apply for permission to work if they have been waiting 12 months for a decision, and they are not considered responsible for the delay. If permission is granted, the person will be allowed to take up jobs on the shortage occupation list only.
what is PSA required for
liquefying the semen
