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MIDS 137 > Ch 4 (normal lower urinary system) > Flashcards

Ch 4 (normal lower urinary system) Flashcards

1
Q

What is the urinary bladder?

A

-Muscular collapsible sac in retroperitoneum on the pelvic floor, posterior to pubic symphysis
-Reservoir for urine

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2
Q

How much urine can an adult bladder hold?

A

500mL, but varies depending on age + health

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3
Q

Which lining of the bladder contains rugae for expansion?

A

The inner mucous membrane of transitional epithelium

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4
Q

How does the bladder membrane appear when it is empty?

A

Folded/wrinkled

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5
Q

What is the bladder trigone?

A

Triangular region on bladder floor that contains no rugae + attaches to muscular coat

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6
Q

How many orifices does the bladder trigone have?

A

3 orifices:

-2 ureters
-1urethra

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7
Q

Which aspect of the bladder do the ureters enter at?

A

Posteroinferior

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8
Q

Where is the urethra orifice located in the bladder?

A

Neck of bladder inferiorly

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9
Q

Are bladder walls normally thicker or thinner when it is empty?

A

Thicker

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10
Q

When the bladder is distended, the bladder can rise how many cm above the symphysis pubis?

A

16 cm

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11
Q

Pelvic structures are best seen when the bladder is full or empty?

A

Full/distended

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12
Q

Do we need full bladder for transvaginal + transrectal scanning?

A

Nope, empty!

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13
Q

The UT + VAG are located b/w what 2 structures?

A

B/w bladder + rectum

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14
Q

Where does the bladder + UT lie when the bladder is empty?

A

-Fundus of bladder lies with anterior wall of VAG + CX
-UT rests on superior surface of bladder

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15
Q

In males, the bladder fundus + body are related to what structure?

A

Rectum

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16
Q

In males, the bladder is separated by what structures?

A

Separated above by rectovesical pouch of petironeum + inferolaterally bilaterally by ducus deferens + seminal vesicles

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17
Q

What are ureters?

A

Tubes that transport urine from kidneys to bladder

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18
Q

Are ureters seen on u/s?

A

No, only if dilated

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19
Q

Measurements of ureters?

A

30cm long, 6mm diameter

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20
Q

Ureters enter the bladder at what portion?

A

Posteroinferior portion

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21
Q

If we see long structures in the adnexa, what may we suspect?

A

-Dilated ureters (can follow up to the kidney to identify)
-Fallopian tubes
-Enlongated cystic mass

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22
Q

UPJ vs UVJ location?

A

Ureteropelvic junction: at kidney
Ureterovesical junction: at bladder

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23
Q

Where does constriction occur at the UPJ?

A

As they cross the iliac vessels

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24
Q

Function of the UVJ?

A

Allows urine to enter bladder + prevents it from being regurgitated

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25
Q

Do kidney stones commonly get stuck in ureters?

A

Yup

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26
Q

What is the urethra?

A

Tube that drains urine from bladder to outside of body

27
Q

Do we see the urethra on u/s?

A

No, only when abnormal

28
Q

What do voluntary + involuntary sphincters do in regards to the urethra?

A

Prevent leaking of urine

29
Q

Length + location of female urethra?

A

3-4cm, posterior to symphysis pubis + anterior to vagina

30
Q

Length of male urethra?

A

20cm

31
Q

Functions of the male urethra?

A

Eliminates urine + passage for semen

32
Q

What is micturition?

A

Voiding of urine

33
Q

How does our body tell our brain we need to urinate?

A

When bladder exceeds 200-400mL there are stretch receptors that trigger the transmission of impulses to our spinal cord which then initiates conscious desire to expel urine

34
Q

How does our body expel urine?

A

Combination of voluntary relaxation of external sphincter muscle of bladder, reflex contraction of linear smooth muscle fibers along urethra, and contraction of detrusor muscle squeezes urine out of bladder

35
Q

What is incontinence?

A

Involuntary emptying of bladder due to aging or trauma to nerves, projection tracts of the cord + brain or motor area of cerebrum

36
Q

6 types of incontinence?

A

-Stress (increased pressure on bladder such as by exercising, sneezing, etc)

-Urge (acute/sudden need to urinate followed by uncontrollable loss of urine)

-Overflow (unable to fully empty bladder, frequent urinary dribble occurs)

-Functional (unable to reach bathroom in time due to physical limitations)

-Mixed (combination of other kinds)

-Bedwetting (nighttime, involuntary urination during sleep)

37
Q

What causes urge incontinence?

A

Infection, diabetes or neurological disorders

38
Q

What type of incontinence is m/c in children?

A

Bedwetting

39
Q

What is retention?

A

Inability to empty bladder, catheterization is often necessary

(the body doesn’t know how much urine to release + is not contracting enough to release it all)

40
Q

2 types of urinary retention?

A

Obstructive: causes blockage of urine flow (ex kidney stones, prostatomegaly, etc)

Non-obstructive: causes a weak bladder muscle + nerve problems that interfere with signals b/w the brain + bladder (due to stroke, pelvic injury, etc)

41
Q

How much water does the pt drink for lower urinary tract exam?

A

16oz of water 1 hour before exam

42
Q

What are alternative options if a pt is not capable of drinking water before an exam?

A

-Ask pt not to void before exam
-Clamp catheter (typically in-patients)
-Catheterization of pt + instilling fluid into bladder (nurse or doctor needs to perform catheterization)

43
Q

What to do if a pt needs to urinate during an exam?

A

Just take cineclips of sweeps through bladder in both planes and let pt go to the bathroom. We can take images off of the cineclips.

44
Q

M/c u/s method to assess the bladder?

A

TA

45
Q

U/s methods used to assess the bladder?

A

-TA (m/c)
-EV
-Endorectally
-Transperineally

46
Q

M/c pt position when scanning bladder?

A

Supine

47
Q

Why would a pt change positions when scanning the bladder?

A

When determining mobility of a structure (ex tumours, debris, stones, etc)

48
Q

SF of a distended/full bladder?

A

-Anechoic
-Echogenic smooth walls
-Reverb echos anteriorly

49
Q

Bladder wall thickness?

A

Less than 3mm when full, up to 5mm when empty

50
Q

How should the bladder look in SAG?

A

Triangular with base parallel with anterior abdominal wall

51
Q

How to measure bladder if exam requires pre + post void measurements?

A

Ensure we are measuring the bladder the same way both times

(either exactly vertical/horizontal or on an angle but 90 degrees across)

52
Q

How does the bladder appear in TRV?

A

Symmetric - superiorly is rounded, inferiorly is square

53
Q

What is a urinary catheter?

A

Flexible tube used to empty bladder + collect urine in a drainage bag

54
Q

SF of urinary catheter?

A

Echogenic circle within bladder lumen

55
Q

How to calculate bladder volume?

A

L x H x W x 0.52

(measure pre + post void)

56
Q

Bladder capacity decreases in association with what?

A

Large pelvic masses, urinary + PID, prostatic hypertrophy, radiation therapy, tumour infiltration + after surgeries

57
Q

When would residual volume increase?

A

With age, atonic bladders, bladder neck obstruction, long term cystitis + advanced invasion by cancer

(elderly people can’t urinate completely)

58
Q

What should the normal post-void volume be?

A

Should be 10% or less of what the pre-void volume is

59
Q

What to do if we think we see a ureter on u/s?

A

-Follow ureters as distally as possible to determine cause of dilatation, then scan up to kidney
-Distal ureters will look anechoic + posterior to bladder
-Use CD, will not have color
-Do height measurements dist, mid + prox to see which area most dilated

60
Q

Which junction are ureteric jets seen at?

A

UVJ (routine bursts of echoes seen)

61
Q

Time interval jets are seen?

A

Typically b/w 5-20 seconds

(assess in TRV with CD)

62
Q

Where to put the CD box in TRV when looking for jets?

A

Males: by prostate
Females: by vagina

63
Q

What is the point of looking for jets?

A

Helps us see if there is an obstruction or not

MIDS 137 (14 decks)

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