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3rd Year Medical Specialties > Elderly - Continence > Flashcards

Elderly - Continence Flashcards

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USMLE® Step 1 flashcards
1
Q

How common is incontinence in patients in hospital care?

A

50-70%

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2
Q

How common is incontinence in patients in nursing home care?

A

40%

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3
Q

How common is incontinence in patients in residential care?

A

25%

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4
Q

Urinary incontinence is most common in which gender?

A

Women (3x as likely)

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5
Q

What are the causes of Urinary incontinence?

A

Extrinsic (environment, habit)

Intrinsic (body)

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6
Q

What are the extrinsic causes of Urinary incontinence?

A 
Physical state
Co-morbidities
Reduced mobility 
Confusion
Drinking too much
Medications
Constipation
Home/social circumstances
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7
Q

What are the muscles of the bladder and urethra, and what is their control?

A

Detrusor - smooth muscle
Internal urethral sphincter - smooth muscle
External urethral sphincter - striated muscle

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8
Q

What is the local innervation of urinary continence?

A

S2-4 (Parasympthetic)
T10-L2 (Sympathetic)
T10-S2 (Sympathetic)
S2-S4 (Somatic)

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9
Q

What is the role of parasympathetic innervation of the urinary system?

A

Increased strength and frequency of contractions

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10
Q

What is the role of Sympathetic innervation of the urinary system?

A

Beta adrenoreceptor - detrusor relaxation

Alpha adrenoreceptor - Contraction of neck of bladder, internal urethral sphincter

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11
Q

What is the role of somatic innervation of the urinary system?

A

Contraction of pelvic floor and external urethral sphincter

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12
Q

What are the neurological controls of micturition?

A

Pontine micturition centre
Frontal cortex
Caudal spinal cord

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13
Q

What are the causes of stress incontinence?

A

Bladder outlet too weak

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14
Q

What are the features of stress incontinence?

A

Urine leak on movement/coughing/laughing
Weak pelvic floor
Common in women with children

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15
Q

What are the treatments for stress incontinence?

A 
Physio (kegel exercises)
Estrogen cream/pessaries
Duloxatine
Surgery (TVT/Colposuspension)
Biofeedback
Pelvic floor stabilisers
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16
Q

What are the characteristic features of overflow incontinence?

A 
Poor flow
Double voiding
Post-micturition dribbling
Blockage to urethra 
Older men - BPH
17
Q

How is overflow incontinence treated?

A

Alpha blockers
Anti-androgens
Surgery - TURP

18
Q

What are the characteristic features of urge incontinence?

A

Detrusor contracts at low volumes
Sudden urge to pass urine
Patients often know every public toilet
Associated with bladder stones or stroke

19
Q

How is urge incontinence treated?

A

Anti-muscarinics

Bladder re-training

20
Q

How to antimuscarinics work for incontinence?

A

Relax detrusor muscle

21
Q

How do Beta-3 adrenoceptor agonists work for incontinence?

A

Relax detrusor muscle

22
Q

How do alpha-blockers work for incontinence?

A

Relax sphincter and bladder neck

23
Q

What is a neuropathic bladder?

A

Bladder that cannot contract, leading to atrophy of the detrusor muscle

24
Q

What are the characteristic features of neuropathic bladder?

A

Secondary to neurological disease (MS, Stroke) or prolonged catheterisation
No awareness of full bladder

25
Q

How is neuropathic bladder treated?

A

Parasympathomimetics (extensive side-effects)

Catheterisation

26
Q

How should incontinence be assessed?

A 
History with extensive social Hx
Intake/Output chart
General exam + rectal and vaginal
Urinalysis and MSSU
Residual bladder scan
Incontinence clinic 
Consider Rx
27
Q

What are the indications for referral to urinary incontinence specialists?

A 
After failure of initial management max 3 months
Fistula
Large residual volume
CNS disease 
BPH
Previous continence surgery
28
Q

When should faecal incontinence be referred?

A

Failure of initial diarrhoea/constipation management
Suspected sphincter damage
Neurological damage

29
Q

What are the last options in incontinent patients?

A 
Pads
Urosheaths
Intermittent catheterisation
Long-term catheter
Suprapubic catheter

3rd Year Medical Specialties (18 decks)

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