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renal > Control of bladder emptying L19 > Flashcards

Control of bladder emptying L19 Flashcards

1
Q

What mechanism is present in the kidney/ureter to help propagate the flow of urine down to the bladder?

A

peristalsis

  • walls of renal pelvis contain atypical smooth muscle cells
  • electrical signals
  • waves of activity initiated
  • move down ureter (also contains smooth muscle)
  • send urine to bladder
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2
Q

what is nephrolithiasis?

A

obstruction to kidney by kidney stones

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3
Q

what is ureterolithiasis?

A

obstruction to calices/ureters by kidney stones

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4
Q

How do kidney stones cause pain?

A
  • cause obstruction to flow
  • increase in pressure in ureter/kidney
  • stretches walls
  • activates sensory fibres
  • pain signal
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5
Q

How can we treat kidney stones? (2)

A
  • percutaneous nephrostomy* - catheter through skin into renal pelvis > drain urine directly > decrease pressure
  • extracorporeal shock wave lithotripsy - high energy ultrasound > disintegrates/ dislodges stones

*could also use to insert probe and remove stone

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6
Q

What is the average empty volume of the urinary bladder?

A

<100ml

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7
Q

What is the maximum volume of the bladder?

A

500-1000mL

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8
Q

what is the normal volume of the bladder?

A

300-500ml

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9
Q

List the components of the bladder wall in order from lumen outwards.

A
  • urothelium
  • lamina propria
  • detrusor smooth muscle
  • serosa (serous membrane tissue)
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10
Q

describe the adaptations of the urothelium as a barrier.

A
  • high-resistance tight junctions between cells to reduce permeability to stop escape of toxic, high osmolality urine into underlying lamina propria
  • umbrella cells - large SA > fewer gaps between cells > reduced permability
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11
Q

describe the function of the urothelium in signalling.

A

urothelail cells release molecules that signal to lamina propria and underlying detrusor the state of bladder (content of urine and volume stored)

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12
Q

What cells run through the lamina propria?

A
  • blood vessels
  • lymph vessels
  • nerves (stretch sensory function)
  • intersitital cells
  • connective tissue
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13
Q

describe the layout of detrusor muscle.

A

irregular ‘basket weave’ of smooth muscle cells so can distend in multiple directions

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14
Q

is the bladder somatically or autonomically innervated?

A

autonomic

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15
Q

describe parasympathetic innervation of bladder.

A
  • dominant innervation
  • main neutrotransmitter is ACh
  • act on M3 muscarinic receptors
  • cause contraction
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16
Q

Describe sympathetic innervation of of bladder.

A
  • main neurotransmitter is noradrenaline
  • act on beta3-adrenoceptors*
  • cause relaxation

*useful therapeutically as not many beta-3 receptors in body > can locally target receptor (agonist/antagonist)

17
Q

sensory nerves to bladder and urethra return to the spinal cord at which levels?

A

S2-S4 and some at upper Lumbar and lower Thoracic levels

18
Q

How do sympathetic and parasympathetic efferent fibres control continence?

A
  • sympathetic NS is active and keeps smooth muscle sphincters constricted
  • parasympathetic NS inactive so bladder remains relaxed
19
Q

How do sympathetic and parasympathetic efferent fibres initiate voiding?

A
  • sympathetic NS inactivated so sphincters relax

- parasympathetic NS activated so bladder contracts

20
Q

Describe the storage reflex pathway.

A

-sensory afferent fibres arise from bladder and travel via pelvic nerve to sacral cord
-afferent fibres synapse in sacral cord and lumbar cord (some ascend)
-autonomic efferent fibres arise from spinal cord and innervate the bladder and smooth muscle sphincters via the hypogastric (lumbar) and pudendal (sacral) nerves.
> activates sympathetic and inactivates parasympathetic > continence
-somatic efferent fibres from the Pontine Micturition Centre (in Pons) descend to the sacral cord where they synapse.
-somatic efferents from the sacral cord travel through the pudendal nerve to activate the external urethral sphincter and keep it contracted.

21
Q

Describe the voiding reflex pathway.

A
  • sensory afferent fibres arise from bladder and travel via pelvic nerve to sacral cord
  • afferent fibres ascend spinal cord to peri-aqueducatal gray in pons where they synapse
  • fibres from PAG travel to Pontine Micutrition Centre where they synapse.
  • efferent fibres from pons descend spinal cord and synapse in lumbar and sacral cords
  • they inhibit sympathetic fibres (hypogastric) and activate parasympathetic fibres (pelvic) to cause voiding
  • somatic fibres to EUS (pudendal) are also inactivated to cause relaxation of sphincter.
22
Q

How do UTIs affect continence?

A

chemical stimuli in bladder wall increase bladder activity and urge to void

23
Q

What conditions can affect urinary continence? (7)

A
  • UTIs
  • SC injury
  • multiple sclerosis
  • stroke (affects central control)
  • pelvic floor injury
  • detrusor overactivity
  • atonic bladder (no tone - cannot contract at all)
24
Q

What factors increase your risk of stress incontinence?

A
  • woman
  • over 40
  • childbirth
25
Q

what is stress incontinence?

A

weak pelvic floor, often caused by increase in intra-abdominal pressure e.g. during coughing, leading to involuntary urine leakage.

26
Q

What treatments are available for overactive bladder? (3)

A
  • antimuscarinic drugs e.g. oxybutynin (short term, side effects incl constipation and bradycardia)
  • botulinum toxin (requires repeated/ongoing treatment)
  • beta-3 receptor agonists e.g. mirabegron ( relaxation of bladder wall - symp)

*begin with antimuscarinics and if it does not work, then beta-3 agonists

27
Q

How do anti-muscarinic drugs prevent incontinence?

A

injected into wall of bladder > prevent release of ACh > decrease force of contraction of detrusor muscle

28
Q

What is the main cause of urinary outflow obstruction (i.e. urethral obstruction)?

A

prostatomegaly - enlargement of prostate

29
Q

What treatments are available for urinary outflow obstruction? (3)

A
  • transurethral resection of the prostate (TURP)
  • alpha-adrenoceptor antagonists > relaxation of smooth muscle of prostate (alpha-adrenoceptors stimulate contraction of smooth muscle) - short term
  • 5alpha-reductase inhibitors - reduce hypertrophy - long term
30
Q

Which part of the spinal cord and which nerve supplies parasympathetic control to the bladder and urethra?

A

sacral s2-s4 - pelvic nerve

31
Q

Which part of the spinal cord and which nerve supplies sympathetic control to the bladder and urethra?

A

lumbar t12-L2 - hypogastric nerve

32
Q

Which part of the spinal cord and which nerve supplies somatic control to the urethral sphincter?

A

sacral s2-s4 - pudendal nerve

renal (16 decks)

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