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MET2 > MET2 Revision 10 > Flashcards

MET2 Revision 10 Flashcards

1
Q

Explain how the micturition reflex works

A

Full bladder: sensory feedback from (S2-4) to micturition centre

micturition centre sends signal to brain to ask if socially acceptable to urinate or not

if yes: able to control sphincter via somatic nature of pudendal nerve AND parasympathetic action of detrusor muscle, contracting the bladder

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2
Q

Hormonal control of bladder:

Normal bladder contraction is caused by the release of []

The release of [] causes the stimulation of [] receptors on the [] smooth muscle

A

Normal bladder contraction is caused by the release of Ach

The release of Ach causes the stimulation of muscarininc (80%: M2) receptors on the detrusor smooth muscle

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3
Q

Which diagnostic score would use to assess micruition? [2]

What would scores be for mild, moderate and severe? [3]

A

Internation Prostate Symptom Score (IPSS)

Mild: 0-7
Moderate: 8-19
Severe: 20-35

AND

Input / Output Chart = voiding diary to create a frequency / volume chart

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4
Q

How would you investigate micturition problems? [6]

A
  • inspect fresh urine sample
  • urine dipstick
  • FBC, PSA (prostatic specific antigen)
  • Uroflowmetry
  • Ultrasound and CT scans
  • Nuclear imaging (for kidney obstruction)
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5
Q

What does a normal flow-rate recording look like? [1]

What ([] ml/s) would demonstrate unobstructed flow-rate [1]

A

Fast and short
20 ml/s = unobstructed

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6
Q

Most common is to have:

voiding symptoms only
storage symptoms only
post-micturition symptoms only
storage & voiding symptoms
storage & voiding & post-mic symptoms

A

Most common is to have:

voiding symptoms only
storage symptoms only
post-micturition symptoms only
storage & voiding symptoms
storage & voiding & post-mic symptoms

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7
Q

What is an important consideration with regards to treating bladders?

A

When a bladder is obstructed, starts to contract a bit randomly: causes changes in pressure (and symptoms)

Bladder isnt overactive - is just blocked.

If treat overactivity then might not do anything - so need to treat blockages

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8
Q

Describe pathophysiology of benign prostate hyperplasia

A

Prostate undergoes hyperplasia - obstructs urethra

Causes detrusor hyperplasia

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9
Q

Effect of caffeine on bladder? [1]

A

Causes release of calcium stores from GA in the bladder wall

Causes contraction more likely

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10
Q

What is urethral milking?

A

Put hands behind testicles and bring forward after urinating to ensure all urine is expelled from U bend in urethra (stops dribbling)

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11
Q

Explain drugs used to treat bladder problems / LUTS [4]

A

alpha blockers(‘stretchers’): stretch prostates open

5-alpha reductase Inhibitors: (‘shrinkers’) shrink prostates

phosphodiesterase-5 (PDE5) inhibitors: PDE5 inhibitors facilitate smooth muscle relaxation through the NO/cGMP pathway, with effects in the bladder, prostate, and urethra.

Antimuscarinics (for OAB)

Combination

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12
Q

What is difference between stress and urge urinary incontinence? [2]
And their sources [2]

A

Stress UI: Leakage on effort or exertion (increased abdominal pressure)

Urge UI: Leakage accompanied by urgency

(stress incontinence – when urine leaks out at times when your bladder is under pressure; for example, when you cough or laugh. urge incontinence – when urine leaks as you feel a sudden, intense urge to pee, or soon afterwards)

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13
Q

Explain how stress incontinence occurs

A

weaking of pelvic floor or urethral sphincter

support is diminished, this causes intra-abdominal pressure to push more urine into urethra

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14
Q

Explain how urge incontinence occurs

A

Larger squeezes on bladder muscle occur

overcomes sphincter and urine comes out urethra

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15
Q

How do you prioritise treatment options for urge incontinence / overactive bladder? [7]

A
  1. Always treat overactive component first
  2. Next approach conservative measures (fluid intake / caffiene / pads)
  3. Next pelvic floor exercises
  4. Tablets
  5. Botox
  6. Posterior and / or sacral nerve stimulation
  7. surgery
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16
Q

Explain 3 drug classes used for urge incontinence / OAB [3]

A

.

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17
Q

Where in the body are regions safe if neurogenic damage occurs? [2]

Where is not safe? [1]

A

Safe:
- Lesions above pontine micturition centre
- Lesions below T12

Unsafe:
- Between mic. centre and T12: causes loss of coordination and raises bladder pressure

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18
Q

what are the 3 branches of the IMA?

what connects the SMA & IMA?

A

inferior mesenteric artery branches:

- left colic artery

- sigmoidal artery

- superior rectal artery

  • SMA & IMA connected by marginal artery
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19
Q

rectal blood supply:

rectum gets supply from which 3 main arteries? where do each of these come from?

A
  • superior rectal artery: from IMA
    middle rectal artery internal iliac artery
    inferior rectal artery from pudendal artery
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20
Q
A
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21
Q
A
22
Q
A
23
Q

explain the Para and sympathetic nerve supply to the gut. what do they normally do

A

(motor component (Parasymp and Sym) of autonomic:)

sympathetic nerves effect (T1-L2)

  • pass through sympathetic trunk & synapse in the abdomen = splachnic nerves
  • inhibits digestion

**parasym nerves (CN III, VII, IX, X & s2-s4)

  • vagus nerve**
    runs up to 2/3 transvers colon. after which sacral nerves take over and supply the hindgut: pelvic splachnic nerves
  • salivation
  • stimulates digestion
  • colon motility
  • urinatin / defecation
24
Q

what are the 3 locations of the ganglia where splachnic nerves (sympathetic NS) synapse?

(ie for foregut ? midgut? hindhut?)

A

if innervating the:

foregut -> coelaic ganglia

midgut -> superior mesenteric ganglia

hindut -> inferior mesenteric ganglia

25
Q
A
26
Q

Which nerves provides the parasympathetic innervation to the rectum, anus, bladder and urethrea? [1]

What are the nerve roots? [1]

A

Pudendal nerve

S2-4

S2, 3, 4 keeps the Penis, Poo and Pee of the floor

27
Q

The EAS is supplied by which nerve?
The IAS is innervated by which NS?
- What are sympathetic and parasympathetic nerve roots?

A

EAS: supplied by inferior branch of the pudendal nerve

IAS: Enteric NS
- Sympathetic: L1-L2 via hypogastric nerves (excitatory)
- Parasympathetic: S2-S4: pelvic nerves (inhibitory)

28
Q

The inferior rectal nerves divides into which two terminal branches? (m v f)

A

M: Perineal nerve and dorsal nerve of the penis

F: Dorsal nerve of the clitoris

29
Q

What factors do we rely on for continence? [5]

A

Anorectal angle
Stool consistency and colonic transit time
Rectal compliance
Rectal filling – sensation
Rectoanal inhibitory reflex (RAIR)

30
Q

How does the anorectal angle work?

A

The tonic contraction produced by the puborectalis muscle, creates what is called a ‘flap valve’

Maintains the angle, whereby the anterior rectal wall is pushed downwards onto the anal canal when the intra-abdominal pressure during straining, laughing and coughing rises, thus stopping the passage of faeces into the anal canal

31
Q

Stool consistency:

Ability of the rectum to retain stool is known as []?

Which two structures provide a mechanical barrier and retard progression of stool? [2]

A

Ability of the rectum to retain stool is known as reservoir continence

Lateral angulations in the sigmoid colon AND the valves of Houston provide a mechanical barrier and retard progression of stool.

It is the weight of the stool that tends to accentuate these angles and thus enhance their barrier effect

32
Q

What is rectal compliance? [1]
Explain how rectal compliance helps continence [1]

A

Rectal compliance: the ability of the rectum to adapt to the imposed stretch is called

Extrinsic afferent neurones mediate the conscious sensation of urgency which is activated by mechanoreceptors.

Got to be full, have to know that it is full

33
Q

Explain what the rectoanal inhibitory reflex (RAIR) is

A

RAIR: a relaxation response in the IAS following rectal distension. Increase in pressure causes the relaxation !

34
Q

Defaction involves the relaxation of which two muscles? [2]

A

EAS and puborectalis muscles

35
Q

Explain proper mechanism for defecation xx

A

Hold breath forcibly trying to exhaled: causes increase in abdo pressure & muscles of the the anterior abdo wall tense to funnel the pressure down to pelvis; Valsalva manoeuvre

Relaxation leads to stool enter lower rectum

36
Q

Explain how the closing reflex occurs

A

Last bolus of stool is passed and then the ‘closing reflex’ of the EAS is stimulated by the releases of traction.

Upon voiding, receptor adaptation in ampulla recti removes inhibitory drive to IAS - thus contraction of IAS

Voluntary contraction of EAS closes anus off.

Smooth muscles in sigmoid relax (enteric nervous system) re-establishing of reservoir function.

37
Q
  • Whats an alarm symptoms for history taking of Ptx with regards to metabolic disoders? [4] * !!!
A
  • Blood in stool
  • Loss of weight
  • Family Hx of colon cancer
  • Rectal bleeding
  • Recent onset of symptoms
38
Q

What is the definition of constipation?

A

purely symptomatic – not at diagnosis

infrequent stools (more than 3 per week) OR

passage of hard stools (less than 25% of the time) OR

a sensation of incomplete evacuation (>25% of the time) or

39
Q

What is primary constipation? [1]

Name 3 types of primary constipation [3]

A

Primary constipation: no identifiable organic cause include:

  • normal transitconstipation: due to inadequate calorie, fibre, or water intake, difficulty with defecation and hard stools, overlap with IBS-C since pain and bloating are common.
  • slow transitconstipation: infrequency and slow movement of stool
    due to bloating, abdominal pain and infrequent urge to defecate (ineffective colonic propulsion due to deficit and abnormalities of the enteric system that has a control on the motility of the large)

- pelvic floor dyssynergia.

40
Q

What is rectal intussusception?

What is rectal prolapse?

A

Rectoanal intussusception: is an invagination of the rectal wall into the lumen of the rectum.

Rectal prolapse: occurs when your rectum, part of your large intestine, slips down inside your anus

41
Q

Name external and internal signs of fecal incontinence (FI)

A

External:
* visible soiling; excoriation (scars/defects)

Internal:
* organic disease (piles, fissures, fistula, tumour);
* defects; tone; squeeze; pelvic floor dysnergia;
* rectocele/intussusception (internal prolapse)

42
Q

What type of imaging is this? [1]

A

Endo-anal ultrasound

43
Q

When do you perform endo-anal ultrasound?

A

Structure
* obstetric sphincter tear
* latrogenic sphincter tear
* radiation damage
* congenital malformations

Function
* pudendal neuropathy

44
Q

What does High Resolution Anorectal Manometry measure / ID? [2]

A

Pressure / time graphs of sphincter or rectum

Sphincter function: Resting pressure, Squeeze pressure, Endurance Squeeze, Rectoanal inhibitory reflex (RAIR)

Rectal sensation:
* hypersensitivity (associated with faecal incontinence)
* hyposensitivity (associated with constipation)

45
Q

Whats a Barium / MRI proctogram?

A

will be asked to lie on your side on the x-ray table whilst barium paste is introduced into your rectum via a small tube. can visualise rectum and colon

46
Q

Name the diagnositic criteria for metabolic syndrome [5]

A

3 of the following:

Waist circumference more than 40 inches in men and 35 inches in women

Elevated triglycerides 150 milligrams per deciliter of blood (mg/dL) or greater

Reduced high-density lipoprotein cholesterol (HDL) less than 40 mg/dL in men or less than 50 mg/dL in women

Elevated fasting glucose of l00 mg/dL or greater

Blood pressure values of systolic 130 mmHg or higher and/or diastolic 85 mmHg or higher

47
Q

What are the triad of symptoms for minimal change disease? [3]

A

Nephrotic syndrome - triad of proteinuria, hypoalbuminaemia and oedema

Minimal change disease is a relatively common cause of nephrotic syndrome and has its name due to renal changes not being seen on a standard microscope. However, under an electron microscope, effacement of the podocyte foot processes can be observed. In minimal change disease, the permeability of the glomerular basement membrane increases, allowing albumin to leak into the urine, causing proteinuria.

48
Q

What are the symptomatic differences between nephrotic and nephritic syndrome?

A

The classic triad in nephrotic syndrome is proteinuria, causing hypoalbuminaemia, which in turn causes oedema

Patients with nephritic syndrome typically present with haematuria, oliguria, and hypertension.

49
Q

IgA nephropathy is a cause of nephritic syndrome and typically occurs a few days following an [] infection

A

IgA nephropathy is a cause of nephritic syndrome and typically occurs a few days following an upper respiratory tract infection

50
Q

Do you use surgery or medication for urge incontinence? [1]
Do you use surgery or medication for stress incontinence? [1]

A

medication for urge incontinence
surgery for stress incontinence

51
Q

Label A-C

A

Rectal intussusception (A),
recto-anal intussusception (B)
and rectal prolapse (C).

MET2 (52 decks)

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