Chapter 27: Disorders of the Bladder and Lower urinary Tract Flashcards
Explain the causes and manifestations that differentiate the two neurogenic bladder disorders, spastic bladder and flaccid bladder.
SPASTIC BLADDER: failure to store
Causes:
Spinal cord injury, herniated interverterbral disc, vascular lesions, myelitis
Manifestations
Reflex bladder spasms cause emptying when not full – muscle shrinks
Overflow dribbling, frequency, nocturia, urgency
FLACCID BLADDER: failure to empty
Causes:
Injury to spinal cord or nerves supplying bladder = detrusor muscle areflexia
Lesions of external sphincter result in non-relaxation
Surgery, inflammation/irritation
Manifestations:
Dribbling, retention
Describe methods used in the treatment of neurogenic bladder.
Catheterization
Bladder training
- Spastic: tap suprapubic or -genitals
- Flaccid: suprapubic pressure
Pharmacology
- Spastic: to decrease detrusor muscle tone
- Flaccid: increase detrusor muscle tone and/or decrease muscle tone of external sphincter
Surgery
Define incontinence and list the categories of this condition.
STRESS:
Weak sphincter d/t
-Age
–Decreased muscle tone
- Neurological damage
- -Congenital, trauma, surgery
- Increased pressure on/in bladder
- -Lifting, coughing, etc.
OVERACTIVE BLADDER/ URGE INCONTINENCE Hyperactive detrusor muscle d/t -Myogenic disorders of bladder’s smooth muscle --Age, diabetes --Elderly males most affected
- Neurogenic disorders
- -CVA, MS, Parkinson
OVERFLOW:
Increased pressure in bladder exceeds sphincter ability to stay closed
- Obstruction (enlarged prostate)
- -BPH, constipation
- lesions
List the treatable causes of incontinence in the elderly.
Causes: 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
Cite organisms most responsible for urinary tract infections (UTIs) and state why urinary catheters, obstruction, and reflux predispose to infections.
Escherichia coli most responsible for UTI
Staphylococcus saprophyticus in uncomplicated UTIs and both non–E. coli gramnegative rods (Proteus mirabilis, Klebsiella species, Enterobacter species, and Pseudomonas aeruginosa) and gram-positive cocci (Staphylococcus aureus) in complicated UTIs
Obstruction and reflux are other factors that increase the risk for UTIs. Any microorganisms that enter the bladder normally are washed out during voiding. When outflow is obstructed, urine remains in the bladder and acts as a medium for microbial growth; the microorganisms in the contaminated urine can then ascend along the ureters to infect the kidneys
Urinary catheters are a source of urethral irritation and provide a means for entry of microorganisms into the urinary tract.
List three physiologic mechanisms that protect against UTIs.
washout phenomenon
Protective mucin layer of bladder
Local immune response
Normal bladder/urethral flora
Men: prostatic fluid (antimicrobial properties)
Described the predisposing factors and manifestations of UTIs
Instrumentation 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
MANIFESTATION:
Dependent on acute/chronic, upper or lower
Frequency, pain (dysuria), cloudy urine
Lower abdominal or back discomfort
Seldom fever
Often relief in 48h on own d/t “washout” of bladder with continuous movement of urine
Compare the signs and symptoms of upper and lower UTIs.
Upper (kidney)
Lower (bladder)
it is dependent on acute or chronic
State the most common sign of bladder cancer.
Manifestations:
Hematuria & therefore anemia
Incontinence, frequency
Dysuria or painless
Discuss the treatment of bladder cancer and how it relates to the extent of the lesion.
Treatment (dependent on degree of invasion)
Excision, cystectomy, radiation, intravesicular chemotherapy
