Chapter 35 Flashcards
How wold urine flow after it leaves the kidneys?
After urine leaves each kidney it passes through the utterers and the ureters carry the urine to the bladder
What are sphincter muscles
Ring shaped muscles that control urine flow
What is the bladder controlled by?
ANS
bladder is a smooth muscle sac
What does the bladder serve as
A temporary reservoir for urine,
where urine stays temporarily
What is the bladder composed of ?
3 layers of muscle tissue called detrusor muscle
What is the detrusor muscle composed of ?
-Inner longitudinal layer
-Middle circular layer
-outer longitudinal layer
What does the sphincter guard?
The sphincter guards opening between urinary bladder and urethra
Why are women more at risk for bladder infection?
Shorter urethra
Men have longer urethra
How many layers does the bladder have?
4
-outer serosal layer
( Covers upper surface and contues with the perioneum)
- Detrusor muscle
(Smooth muscle fibers that does contraction and relaxation)
-Submucosal layer
(Loose connective tissue)
-Inner muscoscal layer
Transitions into epithelium layer
What phases does normal bladder function contain? And what is controlled by
-Storage phase
-Voiding phase
Controlled by brain stem, spinal cord
What is micturution?
Process of producing and voiding
controlled by brain stem and spinal cord
-Activity of smooth muscle of bladder and urethra
How can injries of disease of the nervous system affect adults?
Can disrupt the voluntary center and control of micturition
-Can result in bladder hyperactivity and urge incontinence
What is act of urinination
Micturation or voiding
(process of emptying bladder)
What is the process of emptying out the bladder?
- Detrusor muscle contracts and forces urine out bladder,
- Internal sphincter relaxes so that urine can pass through into urethra
- Muscles of perineum and external sphincter relax and let urine passout
- Small contraction of abdominal wall so urine can pass
- Diaphragm lowers and micturition occurs
What is emptying and storage of urine controlled by?
-Involuntary (Autonomic nervous system)
-Voluntary control (Somatic nervous system )
What does the parasympathetic nervous system do for the bladder?
promote emptying bladder
What does sympathetic nervous system do for the bladder?
Promote the bladder to fill
What provides for voluntary control of bladder?
Striated muscles in the external sphincter and pelvic floor
What are types of alteration in bladder
- Urinary obstruction with urinary retention or stasis ( High risk of infection if urine is not emptying out
-Urinary incontinence with involuntary urine loss(Having loss of pee without control)
What can cause alteration in bladder function?
-Structural changes in bladder, urethra or surrounding organs
-Insult to neurological control which can mess uo blasser function
**Dysuria
What can irritation of trigone cause?
Bladder contraction
What is dysuria?
-Not normal bladder emptying
**Dysuria
what does urethral inflammation or stricture lead to?
difficulty in trying to urine and burning or stinging during urination
What can be causes of dysuria?
-UTI, upper and low
-Lower uti is bladder, higher uti is kidney,urter and bladder
-STI
What are signs and symptoms of dysuria?
-Frequency( constatly in bathroom)
-urgency( Not being able to make it to bathroom
-Painful( All of pain due to bacteria)
What is urinary retention?
When the bladder holds on to urine and doesn’t have complete emptying
What causes urinary retention?
Decreased contractraty( Smooth muscle not contracting and emptying)
-Obstruction to path of urine (like kidney stone )
What are signs and symptoms of urinary retention?
-Sometimes none
-Feeling like having to constantly go (Frequency)
-Not feeling like they are emptying bladder (Incomplete emptying)
-Having to go but make it to the bathroom(Urge incontinence)
-(Overflow incontinence), they already went and thing that they still have to go
What are signs of outflow obstruction and urine retention?
-Bladder distention( Not passing urine, distending in bladder)
-Hesitancy (Needing to go but can’t go)
-Straining when initiating urination(Trying to pee and can’t
-Small and weak stream(A-lot of urine and a little comes)
-Frequency
-Feeling of incomplete bladder emptying
-Overflow incontinence
What is obstructive Uropathy
( Urinary tract obstruction)
-Structural or functional change that interrupt normal urine flow
can lead to renal dysfunction
What can obstructive uropathy be caused by?
-prostate issues( large prostate or cancer
-Calculi (stones)
-anatomic abnormalities
What are signs and symptoms of obstructive uropathy ?
-Pain radiating to back
-Abnormal voiding
-anuria (Not able to make urine
-nocturia or polyuria ( going all night long or a lot of urine)
What is neurogenic bladder?
If you have neurological issue or insult it can lead to lack of bladder control due to brain, spinal cord, or nerve problem
What are common causes of neurogenic bladder?
-Stroke and older patients
-Parkinson disease
-Spinal cord injury
-Radical pelvic surgery
-Diabetes
-Multiple scelerosis
**Nureogenic bladder
What are two dysfunctions that can happen in neurogenic disordeR?
-Spastic bladder dysfunction
-Flaccid bladder dysfunction
What is flaccid bladder dysfunction?
Not contracting or emptying
-Large volume and low pressure
-Contractions are not happening
-Result from peripheral nerve damage or spinal cord damage at s2 or s4 level
What is spastic bladder dysfunction
Not being able to keep urine in bladder
- Volume normal or reduced
-Involuntary contractions
-Result from brain damage or spinal cord injury above t12
-Bladder contraction and extrenal urinary sphincter relaxation do not mathc up with eachother
What are different urinary incontinence?
-Stress incontinence
-Urge incontinence
-overflow incontinence
-Neurogenic incontinence
What is Stress incontinence?
When stress or pressure on your bladder causes you to leak.
Involuntary loss of urine during coughing, laughing, sneezing, or lifting. Increases intra-abdominal pressure
What is urge incontinence?
When you have a strong urge or need to urinate and some leaks out
Involuntary loss of urine associated with a strong desire to void (urgency)
What is overflow incontinence?
Bladder does not empty all the way, this can cause too much urine to stay in bladder. Bladder can become too full and leak urine
Involuntary loss of urine that occurs when intravesicular pressure exceeds the maximal urethral pressure because of bladder distention in the absence of detrusor activity
What is functional Incontinence
Physical or mental disability can make it hard for you to make it to the toilet on time. Doesn’t have to do with urinary tract
What is mixed incontinence?
Could be combination of stress and urge incontinence.
What is total incontinence?
Urine continuously keeps coming out anywhere and anytime of the day.
What is reflex incontinece?
Urinating without feeling the need to
Why is ederly incontinence common?
-Overall capacity of the bladder is reduced.
-Urethral closing pressure is reduced.
-Detrusor muscle function declines with aging.
-Advancing age
-Restricted mobility
-Increased medication
-Comorbid illness
-Infection
-Stool impaction
What is bladder cancer called?
Transitional cell (urothelial) carcinoma
What are stages of transitional cell urothelial carcinoma ?
-Superficial is the epitheilial tissue
- Muscle invasive stage needs procedure and
-Metastic stage is when the cancer cells spread to other parts of the body
What are signs and symptoms of bladder cancer?
-Hematuria, painless hematuria
-Irritation with voiding or frequency and other routes are the problem this can be the problem
