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Bloc D - Renal > Jan23 M1-VUR, Enuresis and Bladder Dysfunction > Flashcards

Jan23 M1-VUR, Enuresis and Bladder Dysfunction Flashcards

1
Q

SS innervation to the bladder and effect

A

Hypogastric nerve. inhibits detrusor muscle

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2
Q

PSS innervation to the bladder and effect

A

pelvic nerve. contrats the detrusor muscle

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3
Q

internal sphincter: type of muscle and innervation

A

SM

hypogastric nerve. closes it (ANS, involuntary)

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4
Q

external sphincter; type of muscle and innervation

A

striated

pudendal nerve. closes it (voluntary control)

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5
Q

dev of urinary control

A

initially spinal reflexes (bladder distension causes bladder contraction).
then higher cortical centers start to control it too and adult pattern assumed by age 4-5

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6
Q

adult pattern of voiding

A

conscious control of detrusor contraction and external sphincter relaxation

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7
Q

incontinence def

A

leakage during the day

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8
Q

signs of voiding dysfunction in kids

A
  • urgency
  • frequency (increased or decreased)
  • nocturia
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9
Q

what can be a cause of weak stream

A

posterior urethral valves (congenital disease)

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10
Q

intermittent stream: in who is it normal

A

kids under 3

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11
Q

holding maneuvers def (seen in kids)

A

behaviors used to postpone voiding (urgency-standing on tiptoe, crossing the legs, squatting,..)

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12
Q

postmicturition dribbling def

A

leaking (unvoluntary) after micturition

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13
Q

etiologies of bladder dysfct in children (3)

A

neurogenic, anatomic, functional

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14
Q

neurogenic causes of bladder dysfct in kids

A

myelomeingocele, trauma to CNS

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15
Q

anatomic causes of bladder dysfct in kids

A
  • ureter insertion distal to the bladder neck

- bladder outlet obsruction (posterior urethral valves, polyuria from renal failure)

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16
Q

functional causes of bladder dysfct in kids

A

(no anat or neuro cause)

  • maturation delay
  • infantile bladder behavior
  • abnormal toilet habits
17
Q

ectopic ureter pathophgy

A

2nd ureteric bud came off to form a third kidney and this bud inserts below the external sphincter

18
Q

EUI in boys

A

usually above external sphincter (no dribbling). may get UTI or prostatitis. epididym infection if inserts in other tract

19
Q

EUI in girls

A

more frequent in girls. small drops (dribbling) coming out of urethra

20
Q

why don’t we pee at night normally

A

ADH is on

21
Q

questions to evaluate for bladder dysfunction

A
  • growth
  • voiding schedule
  • polydipsia
  • bowel habits
22
Q

useful thing to do to evaluate for bladder dysfct

A

ask for 3 day history of voiding and drinking + bowel diary. qtfy everything

23
Q

why voiding related to stooling

A

when you’re constipated, it pushes on the bladder so it doesn’t empty completely

24
Q

2 normal poo shapes and type on the poo scale

A

type 4: sausage

type 5: chicken nuggets

25
Q

physical exam of bladder dysfct in kids

A
  • height and weight + percentile
  • BP (htn = renal disease)
  • neuro (normal reflexes, strength, walking)
  • fecal or urinary staining-palpable bladder
  • external genital exam (skin irritation, urethral meatus, gluteal cleft)
  • psychosocial attitude towards the exam
26
Q

labs investigations in kids with bladder dysfct

A 
UA and micro
U culture
lytes
blood gas
BUN/Cr
27
Q

radiological investigations in kids with bladder dysfct

A
  • lumbosacral spine
  • pain abdominal films
  • US
  • voiding cystourethogram
28
Q

bladder dysfct in kids: when to refer to urology or neurology

A
  • genital exam abnormal
  • lumbosacral spine prob
  • neuro exam abnormal
  • total urinary incontinence
29
Q

Vesico-ureteric reflex (VUR) def

A

congenital defect of how ureter attaches to the bladder

30
Q

VUR associated with what

A

malformations, recurrent UTIs, kidney damage, htn

31
Q

VUR treatment

A

antibiotics + surgery

32
Q

characteristics of uretero-vesical junction (VUR)

A
  • short intravesical ureter
  • enlarged ureteral orifice
  • ectopic ureteral orifice
  • inadequate ureteral SM
33
Q

non pharma treatment for kids with voiding dysfct

A

time voiding

double voiding

34
Q

how to treat type 1-2-3 of poop (hard)

A
  • more dietary fiber

- laxatives

Bloc D - Renal (32 decks)

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