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Physiology 1 > Micturition > Flashcards

Micturition Flashcards

1
Q

What is the ureter made up of?

A

Layers of muscle surrounded by transitional epithelium

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2
Q

What happens when urine enters the ureter?

A

Distends it and smooth muscles around it contracts

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3
Q

What is the frequency of peristaltic waves in the ureter?

A

1-6 contractions per minute

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4
Q

What controls the uretal peristaltic waves?

A

Myogenic nerves (NOT CNS)

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5
Q

How does the ureter open into the bladder?

A

Obliquely

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6
Q

What does the oblique opening of ureters do?

A

Prevents reflux of urine back into the ureters by a passive flap valve effect?

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7
Q

How much urine can the bladder hold without much increase in pressure?

A

400ml

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8
Q

What does the spherical structure of the bladder mean?

A

Pressure spreads equally all over it

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9
Q

What is the internal sphincter of the bladder made up of?

A

It’s an extension of the detrusor muscle

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10
Q

Is the internal sphincter under voluntary control?

A

No

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11
Q

What is the external sphincter made up of?

A

Two striated muscles (compressor urethrae and bulbocavernosus)

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12
Q

What is the external sphincter responsible for?

A

Continence

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13
Q

Is the external sphincter under voluntary control?

A

Yes

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14
Q

What length is the female urethra?

A

Short

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15
Q

What does the male urethra carry?

A

Urine and semen

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16
Q

What is urine elimination aided by in males?

A

Contraction of the bulbocavernosus muscles in penis

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17
Q

Which sex is more prone to incontinence?

A

Females as the external sphincter is less well developed

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18
Q

What is the lining of the bladder made of?

A

Transitional epithelium

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19
Q

What type of muscle is the bladder made up of?

A

Detrusor muscle

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20
Q

Does the composition of urine change in the urinary bladder?

A

No

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21
Q

What is the bladder permeable to?

A

Lipophilic molecules

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22
Q

What is the bladder impermeable to?

A

Salt and water

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23
Q

What is the technical name for kidney stones?

A

Renal calculi

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24
Q

Where can renal calculi form?

A

Anywhere along the urinary tract

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25
Q

What do kidney stones develop from?

A

Crystals that separate from urine within the urinary tract

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26
Q

What are the majority of stones made up of?

A

Calcium (usually as calcium oxaloate or calcium phosphate)

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27
Q

What are other (non calcium) renal calculi made up of?

A

Uric acid, struvite or cysteine

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28
Q

Why are kidney stones more common in men than in women?

A

Testosterone

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29
Q

What are renal calculi caused by?

A
  • Excess dietary intake of stone forming substances
  • poor urinary output/ obstruction
  • altered urinary pH
  • low concentration of inhibitors
  • infection
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30
Q

What is ureterolithiasis?

A

When kidney stones make it into the urethra

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31
Q

What are the symptoms of ureterolithiasis?

A

Dysuria, haematuria, loin/back pain, reduced urine flow

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32
Q

What is renal colic?

A

When a urinary tract obstruction causes the pressure to reach 50 mmHg - considerable pain

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33
Q

What is dysuria?

A

Painful urination

34
Q

What is strangury?

A

Stone approaching the tip of the urethra inhibiting micturition, causing intense pain

35
Q

What is micturition controlled by?

A

Brain and spinal cord

36
Q

Which part of the nervous system does the hypogastric nerve serve?

A

Sympathetic

37
Q

Which part of the nervous system does the pelvic nerve serve?

A

Parasympathetic

38
Q

Which part of the nervous system does the pudendal nerve serve?

A

Somatic

39
Q

What does the sensory (/afferent) nerve do in the bladder?

A

Sensation of fullness and also pain from disease

40
Q

What does the motor (/efferent) nerve do in the bladder?

A

Causes contraction and relaxation of detrusor muscle and external sphincter to control micturition

41
Q

Which ganglia are closer to the bladder?

A

Parasympathetic

42
Q

Do the parasympathetic and sympathetic neurons interact near the bladder?

A

Yes

43
Q

What causes the detrusor muscle to contract (and what receptor)?

A

ACh (muscarinic receptor) or ATP (purinergic receptor)

44
Q

What drug inhibits detrusor contraction?

A

Atropine

45
Q

What inhibits transmission at bladder parasympathetic ganglia and what does this do to the muscle?

A

Noradrenaline- detrusor muscle relaxes

46
Q

What do nitric oxide and ACh do to the internal sphincters and what nervous system do they work on?

A

Relax the internal sphincter - parasympathetic

47
Q

What do noradrenaline do to the internal sphincters and what nervous system do they work on?

A

Contract- sympathetic

48
Q

What does ACh do to the external sphincter and what nervous system do they work on?

A

Holds it closed - somatic

49
Q

What are the two types of afferent nerve fibres in the bladder?

A

A and C

50
Q

What do A fibres in the bladder sense?

A

Tension in detrusor muscle (filling of bladder or muscle contraction)

51
Q

What do C fibres sense in the bladder?

A

Damage and inflammatory mediators

52
Q

What do A fibres in the bladder cause?

A

Bladder fullness/ discomfort

53
Q

What do C fibres in the bladder cause?

A

Pain (urgent need to micturate)

54
Q

Where is the main afferent pathway to the bladder?

A

Pelvic nerve (parasympathetic)

55
Q

What do the small myelinated alpha fibres in the pelvic nerve cause?

A

Micturition reflex

56
Q

Where are the unmyelinated C fibre endings?

A

In/ near the epithelium

57
Q

What type of sensors make up the hypogastric and pudendal pathways?

A

Nociceptors or flow receptors

58
Q

At what urine volume do you get the first desire to micturate?

A

150ml

59
Q

Why are the bladder sphincters closed when the bladder is empty?

A

Tonic activity from the sympathetic and somatic nerves

60
Q

How does the detrusor muscle relax progressively?

A

Sympathetic activity inhibiting the parasympathetic transmission

61
Q

In which groups is micturition an autonomic reflex?

A

Babies or adults with their spinal cord transacted above the sacral region

62
Q

What higher centres are involved in modification of the micturition reflex?

A

Cortical and subcortical areas including specific pontine micturition centre

63
Q

Which parts of the bladder can you contract consciously?

A

External sphincter and elevator muscle

64
Q

What does urethritis do?

A

Cause the urine stream to be halted by strangury

65
Q

What is urethritis?

A

Inflammation of urethra from STI or renal calculi

66
Q

What can inhibit micturition in men?

A

Pinching the glans penis

67
Q

How do you get woken up by needing the toilet at night?

A

If bladder is filled to capacity, its recognised by PMC and arousal centre which wakes you up

68
Q

Why is it important that you completely empty your bladder?

A

If bacteria enters the urine, complete emptying restores the sterility

69
Q

What happens if you retain non-sterile urine?

A

Causes a UTI

70
Q

Where can UTIs happen?

A

Anywhere along the urinary tract

71
Q

What is cystitis?

A

UTI in bladder

72
Q

What is pyelonephritis?

A

UTI in kidneys

73
Q

Which sex are UTIs more common in?

A

Women because of short urethra

74
Q

When do UTIs become common in men?

A

Prostatic disease causes a bladder outflow obstruction

75
Q

What are some risk factors for UTIs?

A

Diabetes mellitus, long term catheterisation, pregnancy, enlarged prostate, prolonged immobility, kidney stones, bowel incontinence

76
Q

Causes of incontinence?

A
  • Weakening of sphincters (stress incontinence)
  • failure of nervous control
  • overactive bladder
77
Q

What is an overactive bladder?

A

Detrusor contracts spastically, resulting in a sustained high bladder pressure

78
Q

What are the treatments available for incontinence?

A
  • Anti-muscarinics
  • bladder retraining
  • surgery
  • sacral nerve stimulation
  • stem cell therapy
  • tissue engineered bladder
79
Q

How do antimuscarinics help treat incontinence?

A

Relax smooth muscle and decrease detrusor contraction

80
Q

What types of incontinence is bladder retraining used for?

A

Stress and urge incontinence

81
Q

How do you retrain your bladder?

A

Kegel exercises

82
Q

What are the two surgeries used for treatment of incontinence?

A

Bladder neck suspension

Botulinum toxin injections into muscles around the urethra -> relaxes bladder

Physiology 1 (65 decks)

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