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GERR Semester 1 > Micturation Control > Flashcards

Micturation Control Flashcards

1
Q

Journey of the urine from kidney to bladder (contractions)

A

Peristaltic waves of contraction brings urine from the pelvis of the kidney to the bladder

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2
Q

What occurs when there is a sufficient amount of urine in the bladder

A

Stretch receptors sense this and cause reflex parasympathetic innervation of the DETRUSOR muscles of the bladder.
This coupled with the relaxation of the external sphincter muscles, allows urine to pass out the urethra and out of the body

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3
Q

What accelerates the process of urination?

A

Abdominal muscles voluntarily cause the forcing of urine out at a faster rate

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4
Q

Voluntary control of micturition is caused by

A

The descending spinal pathways inhibiting parasympathetic output
Additionally stimulating the somatic nerves for the continued contraction of the external urethral sphincter

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5
Q

What spinal damage can mean for micturition

A

Loss of voluntary control of urination
Inability to urinate, ie damage to parasympathetic nerves which supply detrusor muscles. (Ability to empty bladder efficiently is lost

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6
Q

Which 2 types of nerves report about bladder stretch?

A 
Parasympathetic nerves
Sympathetic nerves (hypogastric)
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7
Q

What muscles are the min contractile muscles in. The bladder?

A

DETRUSOR muscles

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8
Q

What effect does sympathetic nerves have in the DETRUSOR muscles?

A

Inhibitory

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9
Q

What effect does parasympathetic nerves have in the detrusor muscles

A

Excitatory effect

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10
Q

Which nerves are internal urethral sphincter muscles innervated by?

A

Sympathetic efferent

Noradrenaline release

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11
Q

What catecholamine is released by the somatic nerves when innervation the external sphincter muscle?

A

Acetylcholine

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12
Q

What innervates the external sphincter muscles of the urethra

A

The somatic motor fibres

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13
Q

What type of nervous innervation stimulates internal sphincter muscles?

Sympathetic or parasympathetic

A

Sympathetic (sympathetic efferent)

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14
Q

What type of nervous innervation stimulates external sphincter muscles?

Sympathetic or parasympathetic

A

Parasympathetic

Somatic nerves

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15
Q

What neurotransmitter is released by sympathetic nerves

A

Adrenaline

Noradrenaline

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16
Q

What neurotransmitter is released by parasympathetic nerves

A

Acetylcholine

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17
Q

Where do somatic nerves enter the spinal cord

A

S2 and S4

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18
Q

Where do the pelvic or parasympathetic nerves emerge

A

S2-S4

19
Q

Where do the sympathetic nerves enter

A

T11-T12

20
Q

What also detects stretch in the bladder

A

ICCs

21
Q

Causes the micturation reflex

2 things

A

Bladder stretch leading to bladder contraction

22
Q

What is the interface layer of the bladder?

A

MUSOCAL LAYER

23
Q

What type of epithelium is in the mucosal layer of the bladder?

A

Transitional epithelium

24
Q

Which layer of the bladder is sensory?

A

Submucosa layer

25
Q

What type of layer is the detrusor layer of the bladder?

A

Contractile

26
Q

What function do PONS have in micturition

A

Speak to higher brain centres

Inhibits parasympathetic efferent

Relaxes bladder

PREVENTS MICTURITION

27
Q

Effect of full bladder on PONS

A

Pons stop inhibiting the parasympathetic efferent and allow contraction of detrusor muscles

28
Q

What do pons do in voiding

A

Stop inhibiting:

Parasympathetic efferents to detrusor = detrusor contraction

Sympathetic efferent signals stopped= internal sphincter relaxes

Somatic efferent signals switched off by PONS= External sphincter relaxes

29
Q

What is an Antonic bladder?

A

A dilated urinary bladdder that does not empty

30
Q

What types of problems could lead to overflow incontinence

4 things

A

BPH (benign prostatic hyperplasia)

Sensory nerve damage during child birth

Anticholergnergic drugs ↓ parasympathetic

Epidurals ↓ sensation

31
Q

Treatments for overflow incontinence (caused by ↓ parasympathetic innervation)

A

M3 Agonist

Catheterisation

Remove prostate

32
Q

What is stress incontinence

A

Voiding of urine upon sneeezing, exercising, coughing

33
Q

How does a weak pelvic floor cause stress incontinence

A

The external urethral sphincter doesn’t function effectively, leading to voiding on coughing/sneezing/exercise

34
Q

Treatments for stress incontinence (Weakness of pelvic floor muscles and external sphincter)

A

Pelvic floor exercises, bladder training, ↓ fluid intake,

Artificial sphincter (external)

35
Q

What is urge incontinence?

A

Overactive bladder, frequency and urgency day and night, with or without loss of bladder control

36
Q

What causes overactive bladder? (Urge incontinence)

A

Oversensitivity due to UTI

Overstimulation of detrusor

Obesity, constipation, diabetes

37
Q

Treatments for overactive bladder (think ↓ parasympathetic)

A

Antimuscarinic medications

Botulinum toxin (↓ AcH release)

Drink more water, bladder training

NSAIDs to ↓ inflammation

38
Q

Neurogenic bladder dysfunction caused by

A

Spinal cord injury

Crush injury

Severance of ascending or descending inputs

39
Q

What would happen if a patient had a T2 spinal cord injury

A

Overactive detrusor, due to no inhibitory influences above

External urethral sphincter unable to relax

Catheterisation needed

No voluntary control of micturition

40
Q

How to reduce overactive voiding in neurogenic bladder dysfunction

A

Muscarinic antagonists

Botox or reduce AcH release

Desensitisation of ICCs with capsaicin

41
Q

What is the function of capsaicin in neurological bladder dysfunction?

A

Desensitises the ICCs to stretch in the bladder

42
Q

What does Botox reduce in parasympathetic neurones

A

Acetylcholine release

43
Q

How are muscarinic antagonists used in treatment of bladder dysfunction/overfunction

A

Prevents parasympathetic stimulation of the DETRUSOR muscles, ↓ voiding potential

GERR Semester 1 (26 decks)

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