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Pathophysiology 212 > Disorders of the Bladder & Urinary Tract > Flashcards

Disorders of the Bladder & Urinary Tract Flashcards

1
Q

Micturition Reflex

A
  • Begins when bladder contains 150-250 mL of urine

- Urine is produced in the kidneys > ureters > bladder fills with urine

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2
Q

Spastic Bladder (failure to store) Causes & Manifestations

A

Causes:
Spinal cord injury, herniated interverterbral disc, vascular lesions, myelitis (inflammation of white or grey matter)
Manifestations
Reflex bladder spasms cause emptying when not full (muscle shrinks)
Overflow dribbling, frequency, nocturia, urgency.

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3
Q

Flaccid Bladder (failure to empty) Causes & Manifestations

A

Causes
Injury to spinal cord or nerves supplying bladder = detrusor muscle areflexia
Lesions of external sphincter result in non-relaxation
Surgery, inflammation/irritation
Manifestations
Dribbling, retention

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4
Q

What methods can be used to determine if a patient has a flaccid bladder?

A
  • Use a bladder scan
  • Catheterization
  • Ultrasound
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5
Q

Neurogenic Bladder Treatment

A
  • Catheterization
  • Bladder training
    Spastic: tap suprapubic or genitals
    Flaccid: suprapubic pressure
  • Pharmacology
    Spastic: to decrease detrusor muscle tone
    Flaccid: to increase detrusor muscle tone and/or decrease muscle tone of external sphincter
  • Surgery
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6
Q

Urinary Incontinence: Types/Causes (1, 2, 3)

A
  1. Stress
    Weak sphincter d/t:
    - Age (decreased muscle tone)
  • Neurological damage (congenital, trauma, surgery)
  • Increased pressure on/in bladder (lifting, coughing)
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7
Q

Urinary Incontinence: Types/Causes (cont) (4)

A 
4. Overactive Bladder/urge incontinence
Hyperactive detrusor muscle d/t
Myogenic disorders of bladder’s    smooth muscle 
- Age, DM
- Elderly males most affected

Neurogenic disorders
- CVA, MS, Parkinson

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8
Q

Urinary Incontinence: Types/Causes (cont) (5)

A
  1. Overflow
    Increased pressure in bladder exceeds sphincter ability to stay closed
    Obstruction (BPH, constipation)
    Lesions
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9
Q

Incontinence and the Elderly: Causes

A

Causes:

  • Capacity of bladder is decreased
  • Ability of urethra to close is limited
  • Degeneration of detrusor muscle
  • Medications
  • Restricted mobility
  • Impaired thirst
  • Comorbid illness/infection
  • Constipation
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10
Q

Incontinence and the Elderly - consequences

A
  • Social isolation, institutionalization

- Predisposes to infections/skin breakdown

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11
Q

Urinary Incontinence Treatment

A
  • Bladder training
  • Encourage fluids to stimulate reflex
  • Limit caffeine/alcohol
  • Pelvic floor muscle exercises & Kegel
  • Establish patterns of elimination
  • Medications
  • Catheterization
  • Surgery
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12
Q

Urinary Tract Infection Definitions

A 
Lower = cystitis (bladder)
Upper = pyelonephritis
Urethritis = inflammation of urethra
Ureteritis = inflammation of ureters

Escherichia coli most common with uncomplicated UTIs

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13
Q

Natural Protection

A
  • Washout phenomenon
  • Protective mucin layer of bladder
  • Local immune response
  • Normal bladder/urethral flora
  • Men: prostatic fluid (antimicrobial properties)
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14
Q

Risks for UTI ?

A
  • Instrumentation
  • Neurogenic disorders (spastic/flaccid)
  • Sexually active, post-menopausal, or diabetic women
  • Men with prostate disease
  • Pregnancy: dilation & displacement
  • Urinary strictures &/or reflux
  • Eldery
  • Poor hygiene or fetal incontinence
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15
Q

Manifestations of a UTI

A
  • Dependent on acute/chronic, upper or lower
  • Frequency, pain (dysuria), cloudy urine
  • Lower abdominal or back discomfort
  • Seldom fever
  • Often relief in 48 hours on own d/t “washout” of bladder
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16
Q

Bladder Cancer

A
  • Cause is unknown but increased risk with
  • Contact with carcinogens (excreted in urine/stored in bladder)
  • Smoking (30-50% of bladder ca’s)
  • Chronic bladder infections/stones
  • Parasite “schistosoma” (common to Egypt & sudan)
17
Q

Bladder Cancer – 2 groups

A
  1. Superficial Bladder Cancer (most common)
    - Confined to mucosa/submucosa
    - Good survival rate if removable, but often recurs
  2. Invasive Bladder Cancer
    - Penetrates deeper layers
    - High fatality rate/metastasis
18
Q

Bladder Cancer Manifestations and Tx

A

Manifestations

  • Hematuria & therefore…anemia
  • Incontinence, frequency
  • Dysuria or painless

Treatment (dependent on degree of invasion)
- Excision, cystectomy, radiation, intra-vesicular - – - chemotherapy

Pathophysiology 212 (18 decks)

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