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Metabolism 2 > Microurition > Flashcards

Microurition Flashcards

1
Q

Explain how micturition physiology works

A
  • Bladder sends a message to the brainstem via S2,3,4 – keeps everything of the floor
  • There is a sensory feedback through pelvis nerves to the micturition centre which asks the rain if it is socially acceptable to pee
  • Brain decides sits and weights
  • Sends a message through the pudendal nerve (somatic – something we control) S2,3,4 to the sphincter
  • Opens the sphincter
  • Reflex action to the parasympathetic system to the bladder
  • Can close pelvic floor voluntarily
  • Or push harder using abdominal muscles \cannot change bladder function as it is a smooth muscle
  • Sympathetic supply to the bladder – hypogastric – blood vessels in the bladder
  • Parasympathetic squeeze – and about erections
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2
Q

describe the storage phase of bladder filling and describe the emptying phase

A

bladder filling

  • detrusor muscle relaxes
  • internal sphincter constricts
  • pelvic floor contracts

emptying

  • detrosur contractions
  • internal sphincter relaxes
  • pelvic floor relaxes
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3
Q

what phase does the bladder spend most of its time in

A
  • spends most of its time in the storage mode
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4
Q

How often does a normal 70Kg adult micturates

A

4 times/24 hours passing 1500mls of urine

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5
Q

how long does each micturition take

A
  • It takes 1 minute to complete so the bladder contracts for only 0.3% of 24 Horus
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6
Q

what is normal bladder contraction stimulated by

A
  • it is caused by release of ACh from cholinergic nerves

- this stimulates muscarinic receptors on the detrusor smooth muscle

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7
Q

what does LUST stand for

A

Lower urinary tract symptoms

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8
Q

what are the types of lower urinary tract symptoms

A
  • Storage irritative symptoms – frequency, nocutria, urgency, urgency incontinence
  • Voiding (obstructive) symptoms – hesitancy, straining, poor flow, intermittency, incomplete emptying – also terminal dribbling, dysuria, haematuria (blood in urine)
  • Overactive bladder (to do with storage symptoms)– urgency with or without incontinence usually with frequency and nocutira
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9
Q

how do you diagnose lower urinary tract symptoms

A
  • Symptom history (acute/chronic, fever, haematuria, trauma)
  • Personal history (smoker, occupation, family history)
  • Past medical history (cardiovascular medicatios/anticoagultnts, previous cancer)
  • Physical examination (vitals, abdominal, external genitalia, external genitalia, DRE)
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10
Q

who is the international prostate symptom score scored by and why is this important

A
  • by the patient

- this is reproducible as well as you can see how the score as changed once you provide intervention

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11
Q

what factors make up the international prostate symptom score

A
  • incomplete emptying
  • frequency
  • incontinency
  • urgency
  • weak stream
  • straining
  • nocturia
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12
Q

what are the levels of the internal prostate symptom score

A

mild 0-7

  • Reassure
  • Watch and wait
  • Reassess regularly
Moderate 8-19 
severe 20-35 
Based on QOFL score 
-	Low QOFL -w atch and wait
-	Med to high QoFL – lifestyle and education, medication, surgery
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13
Q

what investigations can you carry out

A
  • Inspect fresh urine sample
  • Urine dipstick/urine M C and S
  • FBC/UandEs/PSA
  • Uroflowmetery and post void residual volume
  • Urodynamics (Pressure/flow studies)
  • XR KUB
  • Ultrasound KUB and TRUS prostate
  • CT KUB
  • Nuclear imaging
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14
Q

what is flow rate recording

A
  • this records how fast your flow rate is - the patient pees in the funnel and it measures the flow rate
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15
Q

as you get older…

A

urinary flow decreases

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16
Q

what are the disorders grouped into

A 
can be 
- anatomical 
- functional 
- medical 
or 
- outlet 
- pump 
- control 
- constituents
17
Q

name some disorders of

  • anatomical
  • functional
  • medical
A
  • Anatomical disorders – obstructive, incontinence
  • Functional disorders – stroke, spinal cord injury, neurologic disease, idiopathy
  • Medical disorders – cardiac, hepatic and renal failure
18
Q

name some disorders of

  • outlet
  • pump
  • control
  • constituents
A
  • Outlet – bladder neck, prostate, stricture (women rarely get this – underactive bladder is more common), meatus, foreskin
  • Pump 0 bladder – OAB, sensory, failure, cardiac, medications (antipsychotics can do this)
  • Control – neurology – stroke, spina bifida, cord injury, MS, tumour, Parkinson’s
  • Constituents – UTI, cancer, inflammation, stones (ureteric stones and bladder stones)
19
Q 
name some 
- storage 
- voiding 
- both or neither 
symptoms
A

storage

  • incomplete emptying
  • frequency
  • urgency

voiding

  • intermittency
  • weak stream
  • straining

both or niether
- nocturia

20
Q

why does BPH grow inwards and obstruct the bladder

A
  • Humans have a capsule on the prostate like an orange therefore it can only grow so far therefore it can grow inwards and obstructive the urinary tract
21
Q

what is end fill overacitivyt

A

as the bladder is obstructive the bladder over a period of time starts to do its own thing and gets excited near the time it needs to pass urine

22
Q

what is the management of BPH and LUTS

A 
Fluid 
-	Type 
-	Amount 
Bladder drill  - pass urine every 4 hours, try to get them to do that 
Food 
Smoking 
Urethral milking 
Pads and convenes 
Not catheters – last resort and CISC best type
23
Q

what is fluid management

A
  • 1500-2500ml
  • use a voiding diary
  • dry to hold for 4 hours at a time
  • record what you drink and how much
24
Q

what can cause irritant to the bladder

A
  • food and smoking

food such as champagne, chicken liver, onion, curry

25
Q

what is urethral milking

A
  • this is when there is a U band in the uretra
  • the penis is suspended by a suspenocyory ligament
  • urine can get trapped in U band therefore if you lift penis up it can help remove the trap
26
Q

describe medical therapy that can be used for LUST and BPH

A
  • Alpha blockers- Tamsulosin, doxazosin, terazosin – helps symptoms – works on small prostate
  • 5 alpha reductase inhibitors – finasteride, Dutasteride – work on large prostate shrink the bread back
  • PDE5 inhibitors
  • Anitmuscarinocs for OAB
  • Combination
27
Q

what is the surgery for LUTs

A
  • TURP – electic loop to carve out prostatic chips, 1:10 risk of transfusion, TUR syndrome, erection issues
  • HoLEP/Greenlight – modern laser operation, better at tissue remoal, 1;100 risk of transufion, no TUR syndrome, fewer erection issues, expensive, HoLEP any size
  • UroLift – newest technique, pruelry mechanical, preserves erections, 5 year data only, has to be the right shape prostate ad less than 80ml
  • prostatic artery embolism - via a vascular route - has caused a penile embolism and parietal bladder embolism
  • rezum - any shape prostate, steam therapy, no vertical issues - reoperatuion for 20% in 3 years
28
Q

what is urinary urgency

A
  • this can happen with or without incontinence - this is when there is stress on the bladder or an urge problem
29
Q

what is a stress urinary incontinence and what is an urge urinary incotinenace

A
  • Stress UI – leakage on effort or exertion (increased abdonomial pressure)
  • Urge UI – leakage accompanied by urgery
  • Mixed UI – both
30
Q

what is the treatment for urinary incontinance and urge

A 
Treatment 
-	Always treat the overactive component first 
Conservative measures 
-	Fluid intake
-	Caffeine and stimulants 
-	Pads 
-	Timed voiding 
Pelvic floor exercsies – short term use
-	Tablets
-	Posterior tibial nerve sitmulation 
-	Botox 
-	Sacral nerve stimualtin 
-	Surgery
31
Q

what tablets and drugs can you take for OAB/urge incontiance

A

anticholinergics - such as oxybutynin, solifenacin, tolterodine, fesoterodine

  • this blocks acetylcholine in parasympathetic nerves
  • blocks elsewhere too like salivary glands

b3 adrenegics such as mirabegron

  • B3 adrenoreceptors unregulated in OAB
  • hypertension may be an issue

Botulminun Toxin A (BOTOX)

  • fuses synaptic vesicles with motor end plate
  • issues with hyper continence
32
Q

describe where the lesions are in the bladder and what can that mean

A
  • Lesions above the pontine micturition centres are safe e.g. coordinated – CVA, parkinsons, brain injury, MS
  • Lesions in between are unsafe – uncoordinated and thereofre high pressures in the resting bladder results – trauma, tumours, spina bifida
  • Lesions below T12 are safe as bladder and sphincter are flaccid and at low pressure

Metabolism 2 (40 decks)

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