Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

3 - Urinary > deck_1661516 > Flashcards

deck_1661516 Flashcards

1
Q

Give the three main parts of the bladder

A

• Body • Trigone • Neck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Give the histological layers of the bladder wall

A

MUCOSA • Transitional epithelium • Lamina propria • SubmucosaNOT MUCOSA • Detrusor muscle • Adventiia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the body/fundus of the bladder?

A

• Temporary store of urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the trigone?

A

• Ureteric orifices and internal urethral orifice are at the angles of a triangle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the neck of the bladder?

A

• Connects the bladder to the urethra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Outline the structure of the detrusor urinae muscle

A

• Made from a meshwork of muscle fibres in roughly 3 layers ○ Inner longitudinal ○ Middle circular ○ Outer longitundinal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Why does the bladder have three layers of muscle?

A

• Arrangement of muscle gives the bladder strength regardless of direction it is being stretched in

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is detrusor muscle supplied by?

A

• Autonomic nervous system, not under voluntary control Spinal nerve supply is bilateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the internal urethral sphincter?

A

• Continuation of the detrusor muscle and made of smooth muscle • Physiological sphincter at the bladder neck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is a physiological sphincter?

A

• A sphincter which is indistinguishable from surrounding tissue at autopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the primary muscle of continence?

A

• Internal Urethral Sphincter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the external urethral sphincter

A

• Anatomical sphincter ○ Localised circular muscle thickening to facilitate action

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the external urethral sphincter derived from?

A

• Pelvic floor muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What type of muscle is the external sphincter?

A

• Skeletal muscle under somatic, voluntary control • Contracts to constrict urethra and hold in urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the two innervations of the detrusor?

A

• Parasympathetic • Sympathetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Outline the parasympathetic innervation of the detrusor

A

• Pelvic nerve (S2-S4) • Ach - M3 receptorsContraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Outline the sympathetic innervation of the detrusor?

A

• Hypogastric nerve (T10-L2) • NA -> B3 receptors • Relaxation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the innervation of the internal urethral sphincter?

A

• Sympathetic • Hypogastric nerve (T10 - L2) • NA -> a1 receptors • Contraction • Parasympathetic • Pelvic nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the innervation of the external urethral sphincter?

A

• Somatic • Pudendal nerve (S2-S4) • Spinal motor outflow from Onof’s nucelus of the ventral horn of the spinal cord • Ach -> Nicotinic teceptor • Contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the four main functions of the nervous system in relation to the bladder?

A

• Provide sensation of bladder filling and pain • Allow the bladder to relax and accomodate to increasing volumes of urine • To initiate and maintain voiding so bladder empties completely, with minimal residual volume • To provide an integrated regulation of the smooth muscle and skeletal muscle sphincters of the urethra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What prevents retrograde ejaculation in men?

A

• Prostatic urethra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Give the nerve roots which control urine storage

A

• L1 & L2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Give the nerve roots which control bladder voiding

A

S2-S4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the two phases of the bladder?

A

• Emptying • Filling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What occurs in the filling phase?

A

• The bladder relaxes and accommodates increasing volumes of urine • The urethral sphincters increase their tone to maintain continence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What volume of urine is usually required to cause the urge to urinate?

A

• >150ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the overall capacity of the urinary bladder?

A

• 350 - 750ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Outline the nervous pathway which is activated once bladder has a volume of >400ml and urge to urinate arises

A

• Brain micturition centres -> Spinal micturition centres -> parasympathetic neurones -> Pelvic nerve -> Contraction of detrusor muscle -> Rise in intravesicular pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What occurs once there is a rise in intravesicular pressure in the bladder?

A

• Cerebral context makes a concious, executive decision to urinate by reducing sympathetic stimulation to the external urethral sphincter

30
Q

What causes feeling of pain/temperature in bladder as it reaches 400ml filling?

A

• Afferent nerves from the bladder wall start to signal the need to void by producing pain/temperature

31
Q

Outline the nervous pathways which is activated in the filling phase

A

• Brain continence centres -> Spinal continence centres -> Sympathetic neurones -> Hypogastric nerve

32
Q

What does an increase of sympathetic stimulation to the bladder cause in the filling phase

A

• Hypogastric nerve stimulates relaxation of detrusor and contraction of the internal urethral sphincter • Cerebral cortex makes concious executive decision no to urinate by increasing somatic stimulation to the external urethral sphincter

33
Q

What three things must occur for bladder not to empty?

A

• Relaxation of detrusor • Contraction of internal urethral sphincter • Contraction of external urethral sphincter

34
Q

Give four types of urinary incontinence

A

• Stress Urinary Incontinence • Urge Urinary incontinence • Mixed Urinary Incontinence • Overflow Incontinence

35
Q

What is stress urinary incontinence?

A

• Involuntary leakage on effort or exertion, or on sneezing or coughing

36
Q

What is urge urinary incontinence?

A

• Involuntary leakage, accompanied by or immediately proceeded by urgencu

37
Q

What is mixed urinary incontinence?

A

• Involuntary leakage associated with urgency and exertion, effort, sneezing or coughing

38
Q

What is overflow incontinence?

A

• Retention of urine causing the bladder to swell. Can be low pressure and pain free

39
Q

Which type of urinary incontinence has the highest incidence?

A

• Stress urinary incontinence

40
Q

Give three categories of risk factors for urinary incontinence

A

• Obs and Gyny • Promoting • Presdisposing

41
Q

Give three obs and gyny risk factors for urinary incontinence

A

• Pregnancy and childbirth • Pelvic surgery • Pelvic prolapse

42
Q

Give three predisposing risk factors for urinary incontinence

A

• Race • Family predisposition • Anatomical abnormality

43
Q

Give three promoting risk factors for urinary incontinency

A

• UTI • Cognitive impairmentObesity

44
Q

What is an important physiological factor in maintaining continence?

A

• Support of the urethra by the muscles and ligaments of the pelvic floor are important for the efficiency of the sphincter mechanisms of the urethra that enables continence

45
Q

Outline history taking from a patient with a history of Urinary incontinence

A

• Ask to record the amount of fluid they pass for two or three days • Work out the number of pads that the patient has to use per day to cope with urine leakage • Assess whether leakage continous or intermittent • What precipitating factors are present (coughing/sneezing)

46
Q

What can make urgency and frequency of micturition worse?

A

• Intravesicular inflammatory conditions due to UTI, stone in the bladder or tumour

47
Q

How can past medical history assist in the assesment of UTI’s?

A

• Previous surgery of the pelvic floor • Childbirth can cause sphincter damage

48
Q

Outline what information must be gathered in a urinary examination

A

• Height/Weight • Abdominal exam to exclude palpable bladder • Digital rectal examination (DRE) ○ Prostate ○ Limited neurological examination • (Females) External genitalia(Female) Vaginal exam

49
Q

What investigations should be done in the case of urinary incontinence?

A

• Mandatory ○ Urine dipstick • Basic non-invasive urodynamics ○ Frequency volume chart ○ Bladder diary ○ Post micturition residual volume • Optional ○ Invasive urodynamics ○ Pad tests ○ Cystoscopy

50
Q

incontinence What does management of urinary incontinence depend on?

A

• Symptoms patients have • Degree of inconvenience they suffer as a result • Previous or current treatmentsEffects of treatments on other symptoms they may have

51
Q

Outline conservative management of urinary incontinence

A

• Modify fluid intake • Weight loss • Stop smoking • Decrease caffeine intake (UUI) • Avoid constipation • Timed voiding – fixed schedule

52
Q

What treatment can be give to patients who fail conservative management but are unsuitable for surgery?

A

• Indwelling catheter ○ Urethral or suprapubic • Sheath device ○ Analagous to an adhesive condom attached to a catheter tubing and bag • Incontinence pads

53
Q

Give specific management of Stress Urinary Incontinence

A

• Pelvic floor muscle training • 8 contractions, 3x a day • At least 3 months duration • Void bladder, stop stream ß use those muscles in pelvic floor training

54
Q

Give specific management of a urge urinary incontinence?

A

• Bladder training • Schedule of voiding ○ Void every hour during the day ○ Must not void in between – wait or leak ○ Intervals increased by 15-30 minutes a week until interval of 2-3 hours • At least 6 weeks of training needed

55
Q

Give three pharmacological managements of patients with urinary incontinence

A

• Duloxetine • Anticholinergics Botulinim toxin

56
Q

What is duloxetine?

A

• A combined noradrenaline and serotonin uptake inhibitor • Increases the activity od the external urethral sphincter during the filling phase • Offered as alternative to surgery

57
Q

What is an anticholinergic?

A

• Act on muscarininc receptors, including the M3 receptors that cause the detrusor muscle to contract.

58
Q

What is a downside of using an anti-cholinergic to treat urinary incontinence?

A

Many side effects due to effect on muscarinic receptors

59
Q

Why is botulinim toxin sometimes used?

A

• A potent buiological neurtoxin that inhibits Ach release. Prevents detrusor muscle contraction as pelvi nerve cannot release Ach to act on the M3 receptors

60
Q

What are the two main types of surgery in females for urinary incontinence?

A

• permanent intention • Temporary intention

61
Q

Give three types of permanent intention surgery in females

A

• Low tension vaginal tape • Open retropubic suspension procedures • Classic fascial sling procedure

62
Q

What is low tension vaginal tape?

A

• Common, minimally invasive surgery • Success rate of >90% • Supports mid urethra with a polyprophylene mesh

63
Q

What is open retropubic suspension procedure?

A

• Corrects the anatomical position of the proximal urethra and improves urethral support

64
Q

What is the classic fascial sling procedure?

A

• Supports urethra and increases bladder outflow resistance • Involves autologus transplantation of the fascia late or rectus fascia

65
Q

Give a temporary female treatment for urinary incontinence?

A

• Intramural bulking agents improve the ability of the urthera to resist abdominal pressur eby improving urethral coaptation. This is achieved by injetions of autologous fat, silicone, collagen or hylauron-dextran polymers

66
Q

Give two surgical treatments in men for UI

A

• Artificial urinary sphincter • Male sling procedure

67
Q

Outline the insertion of an artificial urinary sphincter in amales

A

• Treatment for urethral sphincter deficiencyCuff is a mechanical device that stimulates the action of a normal sphincter to cicrumferntially close the urethra

68
Q

Give three problems involved in the insertion of an artificial urinary sphincter

A

• Infection • EorsionDevice failure

69
Q

What is a male sling procedure?

A

• Corrects stress urinary incontinence in malesBone anchored tape attached to urethra

70
Q

What is a male sling used to treat?

A

Stress urinary incontinence as a result of radical prostatectomy, colorectal surgery, radical pelvic radiotherapy

3 - Urinary (39 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions