Brainscape's Knowledge GenomeTM

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


See full index

Y3 geriatrics > incontinence > Flashcards

incontinence Flashcards

1
Q

why is incontinence important

A 
common 
stigamatising 
disabling
treatable 
often not treated well 
often becomes permanent if untreated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

prevalence of urinary incontinence

A 
3x more common in women 
prevalence in those living in institutions: 
- residential care - 25%
- nursing home care - 40%
- hospital care - 50-70%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

causes of incontinence

A

extrinsic to the urinary system - environment, habit, physical fitness etc

intrinsic to the urinary system - problem w/ bladder or urinary outlet
often a bit of both

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

extrinsic causes of incontinence

A

physical state
co-morbidities: resp illness (SOB and limited mobility)
confusion: delirium/dementia (challenging to get to the bathroom)
drinking too much or at the wrong time - effort of getting up to drink, nocturnal incontinence if you are drinking lots before bed
medications e.g. diuretics
constipation
home and social circumstances

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

what does continence depend on

A

the effective function of the bladder and the integrity of the neural connections which bring it under voluntary control

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

what are the 2 functions of the bladder

A

urine storage

voluntary voiding

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

types of muscle in the bladder

A

detrusor = smooth
internal urethral sphincter = smooth
external urethral sphincter = striated

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

how much urine can the bladder hold

A

400-600ml

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

storage function of the bladder

A

involves detrusor muscle relaxation w/ filling (<10CM pressure) to normal vol combined w/ sphincter contraction

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

voluntary voiding of the bladder

A

involves voluntary relaxation of external sphincter and involuntary relaxation of internal sphincter and contraction of the bladder

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

local innervation for continence and voiding

A

T10-L2 symp: beta adrenoreceptor, causes detrusor to relax

T10-S2 symp: alpha adrenoreceptor, causes contraction of neck of bladder and IUS

S2-4 parasymp: increases strength and frequency of contractions

S2-4 somatic: contraction of pelvic floor muscle (urogenital diaphragm) and EUS

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

CNS connections to bladder

A

centres within CNS inhibit parasymp tone - promote bladder relaxation and urine storage (normally this tone is constant unless unconscious/seizure etc)

sphincter closure is mediated by reflex increase in alpha adrenergic and somatic activity

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

intrinsic factors affecting incontinence

A

bladder

outlet

too weak/strong

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

what happens if the bladder outlet is too weak

A

stress incontinence

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

clinical features of stress incontinence

A

urine leak on movement, coughing, laughing, squatting etc

weak pelvic floor muscles

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

who gets stress incontinence

A

common in women w/ children, esp after menopause (loss of catabolic hormones which strengthen muscles)

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

treatment for stress incontinence

A

physiotherapy
oestrogen cream/pessary
duloxetine

surgical: TVT/colposuspension - 90% cure at 10yrs

start w/ non-pharmacological first and then work up

18
Q

how does duloxetine work

A

SSRI

19
Q

what are Kegel exercises

A

contraction and relaxation of pelvic floor muscles (3s each) for 10-15x, several times a day

helps strengthen pelvic floor muscles and improve incontinence

can use equipment alongside e.g. vaginal cones, biofeedback

20
Q

what happens if the bladder outlet is too strong

A

urinary retention with overflow incontinence

21
Q

features of urinary retention with overflow incontinence

A

poor urine flow

double voiding

hesitancy

post micturation dribbling

22
Q

what can cause urinary retention with overflow incontinence and who gets it

A

blockage to urethra

older men w/ BPH

sometimes women w/ urethral strictures

23
Q

treatment for urinary retention with overflow incontinence

A

alpha blocker (relaxes sphincter e.g. tamsulosin)

anti-androgen (shrinks prostate e.g. finasteride)

surgery (TURP)

may need catheterisation (suprapubic)

24
Q

what happens if the bladder muscle is too strong

A

urge incontinence

25
Q

features of urge incontinence

A

detrusor contracts at low volumes

sudden urge to pass urine immediately

patients often know every public toilet

26
Q

what can cause urge incontinence

A

bladder stones

stroke

27
Q

what can cause urge incontinence

A

bladder stones

stroke

28
Q

treatment for urge incontinence

A

anti-muscarinic (relax detrusor) e.g. ocybutinin, tolterodine, solifenacin

bladder re-training sometimes helpful

29
Q

side effects of anti-muscarinics

A

blurred vision
confusion
dry mouth - can worsen incontinence by drinking more
stop gastric and colonic peristalsis - constipation
postural instability and orthostatic hypotension

30
Q

4 main drugs used for incontinence

A

anti-muscarinics - relax detrusor

beta-3 adrenoreceptor agonists (relax detrusor)

alpha blockers (relax sphincter, bladder neck)

anti-androgen drugs (shrink prostate)

31
Q

examples of anti-muscarinics

A

oxybutinin

tolterodine

solifenacin

tropsium

32
Q

examples of beta-3 adrenoreceptor agonists

A

miraBEgron

33
Q

examples of alpha blockers

A

tamsulosin
terazosin
indoramin

34
Q

examples of anti-androgen drugs

A

finasteride

dutasteride

35
Q

what happens if you have an underactive bladder

A

neuropathic bladder

36
Q

features of neuropathic bladder

A

‘rare’

2y to neurological disease, typically MS/stroke
also 2y to prolonged catheterisation

no awareness of bladder filling resulting in overflow incontinence

37
Q

treatments for neuropathic bladder

A

medical treatments unsatisfactory

parasympathomimetics might help (pro-cholinergic)
- lots of side effects and quite toxic; reserved for younger pts in ITU rather than elderly

catheterisation is only effective treatment

38
Q

scheme for assessing incontinence

A

hx - may need closed Qs
SHx - impact of incontinence, any extrinsic factors

intake chart and UO

general examination - rectal and vaginal
urinalysis and MSSU
bladder scan for residual vol

consider referral to incontinence clinic for further investigation in difficult cases

suggest lifestyle/behavioural changes and stopping unnecessary drugs
consider physio, medical treatment or surgical options

39
Q

indications for referral to specialists for urinary incontinence

A

referral after failure of initial management

  • max 3mths of pelvic floor exercises, cone therapy, habit retraining and/or appropriate medication
40
Q

when to refer to a specialist straight away for urinary incontinence

A

vesico-vaginal fistula

palpable bladder after micturition or confirmed large residual volume of urine after micturation

CNS disease

certain gynae conditions - fibroids, procidentia, rectocele, cystocele

severe BPH or prostatic carcinoma

pts who have had prev surgery for continence problems

others in whom a dagnosis hasn’t been made

41
Q

indications for referral to specialist - faecal incontinence

A

after failure of initial management - constipation/diarrhoea with normal sphincter

referral necessary at onset: suspected sphincter damage, neurological disease

42
Q

options for incontinence when everything else has failed

A 
incontinence pads
urosheaths
intermittent catheterisation 
long term urinary catheter
suprapubic catheter

Y3 geriatrics (7 decks)

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