Clin Med: GUT Urinary Bladder Flashcards
Reflex IncontinenceUpper Motor Neuron Lesion:
Damage to UMN–> reflex arc is _____
**still INTACT with UMN lesion
Atonic Bladder:
-seen in lesions below ____
- T12–> involving the Cauda Equina and Conus Medullaris
- Bladder is paralysed and there is no sensation of bladder fullness
-Detrusor tone is abolished
Inability to initiate micturition, overflow incontinence and increased residual volume
Atonic Bladder is BEST indicated by 2 signs:
-absent _______
and anal ____
**Absent Bulbocavernosis and Anal wink (S2-4)
Uninhibited bladder= lesion at _____
corticoregulatory tract
Reflex bladder= lesion at
spinal cord ABOVE S2
Autonomous bladder is a lesion at ______
S2, S3, and S4 leve
There are multiple Classification Systems given the multiple etiologies, multiple levels of injury, and multiple components to storage and _______
micturition.
* There are 5 types of neurogenic bladder
Supra-pontine neurologic disorders=
**Loss of tonic inhibition of the PMC. Spontaneous involuntary detrusor overactivity. Storage dysfunction. Examples: CVA, Traumatic brain injury, Normal pressure hydrocephalus, Cerebral palsy, Parkinson’s
Supra-sacral spinal cord/upper motor neuron disorders=
**Detrusor overactivity; storage and emptying dysfunction – urinary urgency/frequency, urge incontinence, intermittent stream, hesitancy; urinary retention (spinal shock initially). Examples: Spinal cord injury, degenerative disc disease, spina bifida.
LMN/neuropathy disorders=
**Detrusor underactivity, urinary retention, impaired sensation. Examples: Diabetes mellitus, peripheral neuropathy, Guillain-Barre
Neurogenic bladder- simplified:
–A lesion above the brain stem affecting micturition can result in _______ ________with coordinated sphincter relaxation, ie urge incontinence, a sudden strong urge to urinate.
**involuntary bladder contractions (detrusor hyperreflexia)
A complete lesion of the spinal cord above ____ vertebral body may leave the spinal reflex center intact, an upper motor neuron lesion. These patients have detrusor ________ and an uncoordinated spastic external sphincter (detrusor-sphincter dysynergy), residual urine with reduced bladder capacity.
- *T12
- hyperreflexia
A lesion to the spinal micturition reflex center or below can lead to a _____ lesion with detrusor ______. Both motor and sensory fibers are affected. Loss of a sense of fullness, weak and unsustained contractions, incomplete bladder emptying with large amounts of residual urine.
**LMN , areflexia.
After injury, a shock phase may last weeks to months. The bladder can have
no sensation and be areflexic.
Bladder dynamics in neurogenic bladders often change over time. Periodic
reevaluation is required.
Complications include: ______
Urinary tract infection, vesicoureteral reflux with damage,
stone formation, incontinence.
Hyperreflexic Bladder: tx?
Decrease residual volume with med (alpha antagonists), surgery (TURP), clean intermittant catheterization, increase functional capacity with meds (anticholinergics), botox, enterocystoplasty.
Areflexic Bladder: tx?
Facilitate complete emptying, Crede, TURP, timed voiding, timed clean intermittent catheterization.
Try to avoid chronic _____
indwelling catheters.
Enterocystoplasty=
Crede=
take the ureters and empty them into a constructed bladder and you can bypass the actual bladder (attach a bag)
crede =outside manual compression
Stress (effort) incontinence:
- 2/2 _____
- demographic?
2/2 increased intra-abdominal pressure under stress (caused by incompetent urethral sphincters and/or weak pelvic floor muscles).
- Coughing, sneezing, bearing down.
- Women, post prostate surgery or radiotherapy in men
Urge incontinence:
- 2/2 _____
- MC in men or women?
**involuntary contraction of bladder muscles. Overactive bladder syndrome.
-MC in men, BPH **
Overflow incontinence:
-2/2 _______
**mechanical blockage of the bladder outlet or neurologic dysfunction of the bladder. Sudden release of urine. **Underactive bladder syndrome
(blockage of the urethra)
Neurogenic incontinence:
-2/2 ______
**impaired neurologic function
Mixed incontinence:
- causes?
- MC in which demographic?
**Multiple causes as noted above. Elderly females.
Motor Supply to bladder musculature, the involuntary sphincter, and striated
external sphincter is from _____ = _____ ______ Center
S2-4
**he Spinal Micturition center
Spinal Micturition center is located at what level?
T12 and L1 vertebral bodies (Conus Medullaris)
Micturition Reflex is coordinated in the ______
Pontine Micturition Center. (PMC)**
Anat. of urine storage and voiding: (all the components)
-Autonomic Nervous System (SNS and PSNS) and Somatic NS
-PSNS from pelvic nerves arising from _____, The Spinal Micturition Center, carries
motor and stretch sensory receptors
-SNS carries motor and sensory (____, ____, _____) from Thoracolumbar
segments _____
-Pudendal Nerve (Striated external sphincter and UG Diaphragm) motor
and Sensory Somatic fibers from _____
-PMC = Pontine Micturition Center
-S2-4
- pain, touch, and temperature
- T11- L2
-S2-4.