Ch. 27 Disorders of the Bladder and Lower Urinary Tract Flashcards
What is overactive bladder/urge incontinence?
Hyperactive detrusor muscle
What causes overactive bladder/urge incontinence?
Myogenic disorders of bladder’s smooth muscle Age Diabetes Mellitus Elderly males most affected Neurogenic disorders CVA, MS, Parkinson’s
What is urinary overflow?
Increased pressure in bladder exceeds sphincter ability to stay closed
What can cause urinary overflow?
Obstruction (BPH, constpiation)
Lesions
What are causes of incontinence in the elderly?
Capacity of bladder is decreased Ability of urethra to close is limited Degeneration of detrusor muscle Medications Restricted mobility Impaired thirst Comorbid illness/infection Constipation
What are ways to treat urinary incontinence?
Bladder training Encourage fluids to stimulate reflex Limit caffeine/alcohol Pelvic floor muscle exercises & Kegel Establish patterns of elimination Medications Catheterization Surgery
What is spastic bladder?
Failure to store urine
What causes spastic bladder?
Spinal cord injury
Herniated intervertebral disc
Vascular lesions
Myelitis
What are the manifestations of spastic bladder?
Reflex bladder spasms cause emptying when not full (muscle shrinks)
What is flaccid bladder?
Failure of the bladder to empty.
What are the causes of flaccid bladder?
Injury to spinal cord or nerves supplying bladder
Lesions of external sphincter result in non-relaxation
Surgery
Inflammation/irritation
What are the manifestations of flaccid bladder?
Dribbling, retention
What are the treatments for neurogenic bladder?
Catheterization Bladder training Spastic: tap suprapubic or genitals Flaccid: suprapubic pressure Pharmacology Spastic: to decrease detrusor muscle tone Flaccid: to increase detrusor muscle tone and/or decrease muscle tone of external sphincter Surgery
What is stress incontinence?
Weak sphincter due to: Weak sphincter d/t Age Decreased muscle tone Neurological damage Congenital, trauma, surgery Increased pressure on/in bladder Lifting, coughing, etc.
What are the four types of urinary tract infections?
Lower = cystitis (bladder) Upper = Pyelonephritis Urethritis = inflammation of urethra Ureteritis = inflammation of ureters
What is the most common causitive organism for UTI?
E. Coli
What are the body’s forms of natural protection against UTIs?
Washout phenomenon Protective mucin layer of bladder Local immune response Normal bladder/urethral flora Men: Prostatic fluid (antimicrobial properties)
What are the risk factors for UTI?
Instrumentation (Foley catheter) Neurogenic disorders (spastic/flaccid) Sexually active, post-menopausal, or diabetic women Men with prostate disease Pregnancy (dilation & displacement) Urinary strictures and /or reflux Elderly Poor hygiene/fecal incontinence
What are the manifestations of UTI?
Frequency, pain (dysuria), cloudy urine
Lower abdominal or back discomfort
Seldom fever
Often relief in 48 hours on own due to “washout” of bladder with continuous movement of urine
How does the bladder filling with urine trigger a parasympathetic response?
Bladder fills, stretch receptors stimulate spinal reflex, parasympathetic neurons signal the detrusor muscle to contract and internal sphincter relax
What are the risk factors associated with bladder cancer?
Contact with carcinogens
Smoking
Chronic bladder infections/stones
Parasite “schistosoma” common to Egypt and Sudan
What are the two types of bladder cancer?
Superficial bladder cancer
Invasive bladder cancer
What is superficial bladder cancer?
Confined to mucosa/submucosa
Good survival rate if removable, but often recurs
What is invasive bladder cancer?
Penetrates deeper layers
High fatality rate/metastasis
What are the manifestations of bladder cancer?
Hematuria (and therefore anemia)
Incontinence, frequency
Dysuria (or painless)
What are the treatments for bladder cancer?
Excision, cystectomy, radiation, intra-vesicular chemotherapy
How does the micturition center allow conscious control of the bladder?
Bladder fills with urine, stretch receptors cause micturition center in pons to be stimulated, detrusor muscle contracts, external and internal sphincters relax
