CH. 35 Disorders of the bladder and Lower urinary tract

Question 1

Structure of the bladder

Answer 1

Fundus (body)
Neck (posterior urethra) 
four layers
Outer serosal layer: 
Detrusor: network of smooth muscle. muscle of micturition. makes part of the internal sphincter. 
Submucosal: 
Inner mucosal lining:

Question 2

LUT

Answer 2

bladder, urethra, and prostate

Question 3

Trigone region

Answer 3

made by urethra, and ureters.

Question 4

Spinal cord reflex centers

Answer 4

controlled through sacral (s1-s4) and thorcolumnar t11-l2.

controlled by the pons and cortical areas.

Question 5

Storage and emptying of urine

Answer 5

involves involuntary and voluntary control
the parasympathetic nervous system promotes bladder emptying
the sympathetic nervous system promotes bladder filling
striated muscles in the external sphincter and pelvic floor provide for voluntary control of urine.
low pressure urine storage.

Question 6

Uroflowmetry

Answer 6

measures the flow rate ml per minute during urination

Question 7

cystometry

Answer 7

measure bladder pressure during filling and voiding

Question 8

urethral pressure profile:

Answer 8

evaluate the intraluminal pressure changes along the length of the urethra with the bladder at rest

Question 9

bladder scan

Answer 9

how much urine is left after urination. 50-200 means that is having a greater difficulty emptying

Question 10

sphincter electromyography:

Answer 10

activity of the striated voluntary muscles of the perineal area to be studied.

Question 11

Urinary obstruction with retention or stasis of urine

Answer 11

structure changes in the bladder, urethra, or surrounding organs. can be congenital. acquired: older people prostate problems, gonorrhea or STIs (urethral stricture)
fecal impaction, pregnancy, cancer, deformities.

Question 12

Urinary incontinence with involuntary loss of urine

Answer 12

impairment of neurologic control of bladder function.

Question 13

Signs of outflow obstruction and urine retention

Answer 13

bladder distention, hesitancy, straining when initiating urination, small and weak stream, frequency, feeling of incomplete bladder emptying, overflow incontinence.
Compensatory stage: detrusor hypertrophies, hesitancy, straining,
Decompensatory stage:: the bladder continues to fill, small streams, bladder never fully empties.

Question 14

Spastic Bladder Dysfunction

Answer 14

failure to store urine. neurologic lesions above level of the sacral cord allow neurons in the micturition center to function reflexively without control from the CNS centers

Question 15

Flaccid bladder dysfunction

Answer 15

bladder emptying is impaired.
neurologic disorders affect motor neurons in the sacral cord or peripheral nerves that control detrusor muscle contraction and bladder emptying

Question 16

Common cause of neurogenic bladder

Answer 16

stroke and advanced age, parkinson disease, spinal cord injury, injury to sacral cord or spinal roots, radical pelvic surgery

Question 17

Urge incontinence/ overactive bladder

Answer 17

involuntary loss of urine associated with a strong desire to void
OAB is used to describe dysuria and nocturia. can occur without incontinence. involuntary bladder contractions

Question 18

Overflow incontinence

Answer 18

loss of urine when intravescular pressure exceeds the maximal urethral pressure because of bladder distention in the absence of detrusor activity
In men: most is obstructive with the enlargement of the prostate gland. another cause commonly overlooked is fecal impaction

Question 19

Functional incontinence

Answer 19

caused by factors outside the lower urinary tract, such as the inability to locate, reach, or receive assistance in reaching an appropriate place to void.

Question 20

Treatment options for incontinence

Answer 20

depend on the type, accompanying health problems and age.
behaviors and pharmacological measures, exercises to strengthen the pelvic muscles, surgical correction, noncatheter devices to obstruct the flow or correct, indwelling caths, self caths

Question 21

Elderly incontinence

Answer 21

overall capacity of the bladder is reduced, urethral closing pressure is reduced, detrusor muscle function declines with agings (large PVR volumes), advacning age, restricted mobility, increased medication, comorbid illness, infection, stool impaction

Question 22

Bladder Cancer Signs

Answer 22

Increased frequency, urgency, dysuria, hematuria. painless hematuria.

Question 23

Diagnostic measures of Bladder cancer

Answer 23

cytologic, exretory, cystocopy, biopsy, ultrasound, CT, MRI

Question 24

Cancerous Lesion Types

Answer 24

Superficial

Invasive

Question 25

Bladder Cancer Risk Factors

Answer 25

family history, smoking, exposure to chemicals, over the age of 55

Question 26

Treatment for Bladder Cancer

Answer 26

cytologic grade of the tumor, the lesions degree of invasiveness.
Surgical removal, radiation, chemotherapy.