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Pathophysiology II class notes > Ch. 27 Disorders of the Bladder and Lower Urinary Tract > Flashcards

Ch. 27 Disorders of the Bladder and Lower Urinary Tract Flashcards

1
Q

What is overactive bladder/urge incontinence?

A

Hyperactive detrusor muscle

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2
Q

What causes overactive bladder/urge incontinence?

A 
Myogenic disorders of bladder’s    smooth muscle 
Age
Diabetes Mellitus
Elderly males most affected
Neurogenic disorders 
CVA, MS, Parkinson’s
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3
Q

What is urinary overflow?

A

Increased pressure in bladder exceeds sphincter ability to stay closed

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4
Q

What can cause urinary overflow?

A

Obstruction (BPH, constpiation)

Lesions

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5
Q

What are causes of incontinence in the elderly?

A 
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
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6
Q

What are ways to treat urinary incontinence?

A 
Bladder training
Encourage fluids to stimulate reflex
Limit caffeine/alcohol
Pelvic floor muscle exercises & Kegel 
Establish patterns of elimination
Medications
Catheterization
Surgery
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7
Q

What is spastic bladder?

A

Failure to store urine

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8
Q

What causes spastic bladder?

A

Spinal cord injury
Herniated intervertebral disc
Vascular lesions
Myelitis

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9
Q

What are the manifestations of spastic bladder?

A

Reflex bladder spasms cause emptying when not full (muscle shrinks)

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10
Q

What is flaccid bladder?

A

Failure of the bladder to empty.

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11
Q

What are the causes of flaccid bladder?

A

Injury to spinal cord or nerves supplying bladder
Lesions of external sphincter result in non-relaxation
Surgery
Inflammation/irritation

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12
Q

What are the manifestations of flaccid bladder?

A

Dribbling, retention

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13
Q

What are the treatments for neurogenic bladder?

A 
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
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14
Q

What is stress incontinence?

A 
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.
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15
Q

What are the four types of urinary tract infections?

A 
Lower = cystitis (bladder)
Upper = Pyelonephritis
Urethritis = inflammation of urethra
Ureteritis = inflammation of ureters
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16
Q

What is the most common causitive organism for UTI?

A

E. Coli

17
Q

What are the body’s forms of natural protection against UTIs?

A 
Washout phenomenon
Protective mucin layer of bladder
Local immune response 
Normal bladder/urethral flora
Men: Prostatic fluid (antimicrobial properties)
18
Q

What are the risk factors for UTI?

A 
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
19
Q

What are the manifestations of UTI?

A

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

20
Q

How does the bladder filling with urine trigger a parasympathetic response?

A

Bladder fills, stretch receptors stimulate spinal reflex, parasympathetic neurons signal the detrusor muscle to contract and internal sphincter relax

21
Q

What are the risk factors associated with bladder cancer?

A

Contact with carcinogens
Smoking
Chronic bladder infections/stones
Parasite “schistosoma” common to Egypt and Sudan

22
Q

What are the two types of bladder cancer?

A

Superficial bladder cancer

Invasive bladder cancer

23
Q

What is superficial bladder cancer?

A

Confined to mucosa/submucosa

Good survival rate if removable, but often recurs

24
Q

What is invasive bladder cancer?

A

Penetrates deeper layers

High fatality rate/metastasis

25
Q

What are the manifestations of bladder cancer?

A

Hematuria (and therefore anemia)
Incontinence, frequency
Dysuria (or painless)

26
Q

What are the treatments for bladder cancer?

A

Excision, cystectomy, radiation, intra-vesicular chemotherapy

27
Q

How does the micturition center allow conscious control of the bladder?

A

Bladder fills with urine, stretch receptors cause micturition center in pons to be stimulated, detrusor muscle contracts, external and internal sphincters relax

Pathophysiology II class notes (15 decks)

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