Clin Med: GUT Urinary Bladder

Question 1

Reflex IncontinenceUpper Motor Neuron Lesion:

Damage to UMN–> reflex arc is _____

Answer 1

**still INTACT with UMN lesion

Question 2

Atonic Bladder:

-seen in lesions below ____

Answer 2

• 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

Question 3

Atonic Bladder is BEST indicated by 2 signs:
-absent _______
and anal ____

Answer 3

**Absent Bulbocavernosis and Anal wink (S2-4)

Question 4

Uninhibited bladder= lesion at _____

Answer 4

corticoregulatory tract

Question 5

Reflex bladder= lesion at

Answer 5

spinal cord ABOVE S2

Question 6

Autonomous bladder is a lesion at ______

Answer 6

S2, S3, and S4 leve

Question 7

There are multiple Classification Systems given the multiple etiologies, multiple levels of injury, and multiple components to storage and _______

Answer 7

micturition.

* There are 5 types of neurogenic bladder

Question 8

Supra-pontine neurologic disorders=

Answer 8

**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

Question 9

Supra-sacral spinal cord/upper motor neuron disorders=

Answer 9

**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.

Question 10

LMN/neuropathy disorders=

Answer 10

**Detrusor underactivity, urinary retention, impaired sensation. Examples: Diabetes mellitus, peripheral neuropathy, Guillain-Barre

Question 11

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.

Answer 11

**involuntary bladder contractions (detrusor hyperreflexia)

Question 12

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.

Answer 12

• *T12

- hyperreflexia

Question 13

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.

Answer 13

**LMN , areflexia.

Question 14

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: ______

Answer 14

Urinary tract infection, vesicoureteral reflux with damage,

stone formation, incontinence.

Question 15

Hyperreflexic Bladder: tx?

Answer 15

Decrease residual volume with med (alpha antagonists), surgery (TURP), clean intermittant catheterization, increase functional capacity with meds (anticholinergics), botox, enterocystoplasty.

Question 16

Areflexic Bladder: tx?

Answer 16

Facilitate complete emptying, Crede, TURP, timed voiding, timed clean intermittent catheterization.

Question 17

Try to avoid chronic _____

Answer 17

indwelling catheters.

Question 18

Enterocystoplasty=

Crede=

Answer 18

take the ureters and empty them into a constructed bladder and you can bypass the actual bladder (attach a bag)

crede =outside manual compression

Question 19

Stress (effort) incontinence:

• 2/2 _____
• demographic?

Answer 19

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

Question 20

Urge incontinence:

• 2/2 _____
• MC in men or women?

Answer 20

**involuntary contraction of bladder muscles. Overactive bladder syndrome.

-MC in men, BPH **

Question 21

Overflow incontinence:

-2/2 _______

Answer 21

**mechanical blockage of the bladder outlet or neurologic dysfunction of the bladder. Sudden release of urine. **Underactive bladder syndrome

(blockage of the urethra)

Question 22

Neurogenic incontinence:

-2/2 ______

Answer 22

**impaired neurologic function

Question 23

Mixed incontinence:

• causes?
• MC in which demographic?

Answer 23

**Multiple causes as noted above. Elderly females.

Question 24

Motor Supply to bladder musculature, the involuntary sphincter, and striated
external sphincter is from _____ = _____ ______ Center

Answer 24

S2-4

**he Spinal Micturition center

Question 25

Spinal Micturition center is located at what level?

Answer 25

T12 and L1
vertebral bodies (Conus Medullaris)

Question 26

Micturition Reflex is coordinated in the ______

Answer 26

Pontine Micturition Center. (PMC)**

Question 27

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

Answer 27

-S2-4

• pain, touch, and temperature
• T11- L2

-S2-4.