L17: Control Of Bladder Emptying Flashcards
Where does urine from to after the collecting duct
Minor calyx
Where does urine flow to after the minor calyx
Major calyx
Where does urine flow to after the major calyx
Renal pelvis
Where does urine flow to after the renal pelvis
Ureter
What can obstruct the ureter
Kidney stones
Tumours
Fibrosis
What is the treatment for kidney stones in the ureter
Removal
Extracorporeal shock wave lithotripsy
What are the layers of the urinary bladder form inside to outside
Urothelium
Lamina propia
Detrusor smooth muscle
Serosa
What type of junctions does the urothelium have
Tight junctions
What does the urothelium have tight junctions
So fluid cannot pass into it
What does the lamina propia contain
Blood vessels
Lymphatics
Nerves
Intersitial cells of CAJAL
What does the sensory nerves in the lamina propia detect
Chemical
Stretch
What nervous system is the detrusor smooth muscle innervated by
Parasympathetic
Sympathetic
What neurotransmitter does the parasympathetic post ganglionic neurones release
Acetylcholine
What neurotransmitter does the post ganglionic sympathetic neurone release
Noradrenaline
Which receptors does acetylcholine act on the detrusor smooth muscle
Muscarinic 3 receptor
Which receptors does noradrenaline act on the detrusor smooth muscle
Beta 3 receptor
What does parasympathetic innervation to the detrusor muscle to do
Contraction to expel urine out
What does the sympathetic nervous system cause the detrusor muscle to do
Relaxation to store urine
What does continence mean
To not urinate
What does void mean
Empty the bladder and urinate
What happens to the pressure inside the bladder when we are continent
Decreases
What happens to the sphincters during continence
Activated/contract
What happens to the pressure inside the bladder when we void
Increase due to a contraction of the muscle
What happens to the sphincters when we void
Relax
Which floor does the bladder sit on top of
The pelvic floor
What is the pelvic floor made of
Levator ani
Coccygeous
What is the levator ani made of
Pubococcygous
Iliococcygeous
puborectalis
When can the pelvic floor weaken
In childbirth
What are the types of innervation of the urethra
Somatic
Autonomic
Which part of the urethra does the somatic system innervate
External urethral sphincter that has Striated skeletal muscle
Which layer of the urethra does the autonomic nervous system innervate
Smooth muscle
Describe the process that occurs during continence
1) somatic NS innervated the external urethral sphincter so it is contracted
2) sympathetic NA is activated which contracts the internal urethral sphincter (inside the bladder)
3) parasympathetic NS is inactive
Describe what happens during voiding
1) somatic and sympathetic NS are inactivated
2) parasympathetic NS is activated which causes the detrusor muscle to contract and void
What type of innervation does the pudenal nerve have
Somatic
What does the pudenal nerve supply
The external urethral sphincter
What type of innervation does the Pelvic nerve have
Parasympathetic
What does the pelvic nerve supply
The detrusor smooth muscle
What type of innervation does the hypogastric nerve have
Sympathetic
What does the hypogastric nerve supply
Internal urethral sphincter
Detrusor smooth muscle
Where does the sensory nerves send the signal to
Pontine micturition centre
When does stress in continence
When the abdominal pressure increases when you cough or sneeze
Why does stress incontinence occur in females after childbirth
Anterior vaginal walls is damages so posterior wall of urethra collapses open
What is the treatment for stress incontinence
Surgical by addition support to the anterior vaginal wall
Pelvic floor exercises
What are the pharmacological interventions for an overactive bladder
Antimuscarinic drug
Botulinum toxin to stop PNS
B3 adrenoceptor agonist
What is the treatment for benign prostatic hyperplasia
Surgical: reduce size
Medical: alpha adrenoceptor antagonist
