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Renal > Micturition > Flashcards

Micturition Flashcards

1
Q

What is responsible for continence ?

A

Intrinsic sphincter - bladder neck muscle fibers mid-urethral (membrane/prostate in males) complex

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2
Q

What interrupts stream?

A

rhabdosphincter

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3
Q

Parasympathetic innervation (Pelvic nerve s2-4)

A

Detrusor muscle - micturition upon contraction

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4
Q

Motor innervation (CNS)

A

bladder, pelvic floor, urethral sphincter (s2-4) - sensation of bladder fullness or stretch are conveyed through long neurons from spinal cord to pons

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5
Q

Sympathetic (ANS)

A

T10-L2 = Inhibits detrusor and increases tension in the smooth muscle of the bladder neck and proximal urethra

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6
Q

Higher order control

A

Cortex - inhibitory over sacral centers (think disease and incontinence / stroke)

Cerebellum/Brainstem - facilitory

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7
Q

Root with motor

A

ventral

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8
Q

Root with sensory

A

dorsal

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9
Q

Dysfunction of bladder storage phase (normally neuromuscular adaption allows minimal pressure change with increased volume) — dysfunction

A

frequency, urgency, and urge incontinence - OAB

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10
Q

Storage phase

A

allows bladder to adapt to increasing volume with little changes in pressure (affarent pelvic nerve fibers to DRG) (Efferent pudendal via VH - inhibit detrusor - somatic and cortical)

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11
Q

What causes detrusor contraction

A

PS of pelvic nerve

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12
Q

2 functions of bladder

A

store and empty urine

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13
Q

Urine empty must override storage - dysfunction

A

hesitancy / weak stream / incomplete empty

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14
Q

5 steps of bladder emptying

A

increase in bladder wall tension

affarent input overcomes pontine micturition center threshold and povides cortical egress micturition begin

pudendal nerve (SMN) activity ceases (relax), the external sphincter and pelvic floor relaxes (SN), detrusor neurons (PS) are freed and discharge

proxmial urethra opens

bladder immediately contracts

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15
Q

micturition cycle dysfunction

A

hesitancy / weak stream / retention

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16
Q

efferent response to bladder filling?

A

pudendal s2-s4 (somatic) - associated with cortical inhibition of detrusor

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17
Q

step 1 voiding?

A

increase wall tension in bladder

18
Q

Step 2 voiding (After increase in wall tension)

A

affarent input overcomes the pontine micturition center threshold and provides cortical egress –> micturition begins

19
Q

step 3 voiding (After cortical egress initiates micturition)

A
  1. pudendal (SMN) relax
  2. External sphincter/pelvic floor relax (SM)
  3. Detrusor (PS) freed from inhibition
20
Q

Step 4 voiding (after inhibition ceases)

A

proximal urethra opens

21
Q

step 5 voiding (after urethra opens)?

A

bladder contracts

22
Q

what monitors bladder?

A

pelvic nerve affarents

23
Q

somatic pudendal nerves?

A

constrict urethral sphincter

24
Q

lumbar sympathetic nerves

A

inhibit bladder

constrict sphincter

25
Q

pelvic PS nerves

A

contract blader

inhibit sphincter contraction

26
Q

2 main causes of incontinence

A

stress

urge

27
Q

OAB (urge) usually due to?

A

neurological problem

treat with Anticholinergics

28
Q

drug for OAB

A

Oxybutynin
CytP450 3A4
Dries you out

29
Q

involuntary sudden loss of urine during increases in intra abdominal pressure

A

Stress incontinence

30
Q

Treat stress incontinence with?

A

ephedrine

estrogen

31
Q

UTO most common in men?

A

BPH

32
Q

BPH symptoms UTO

A

Frequency / urgency /

Hesitancy / decreased stream

33
Q

Storage issues

A

frequency urgency

34
Q

emptying issues

A

hesitancy straining weak stream

35
Q

% 80 year olds with BPH

A

80

50% with symptoms

36
Q

% 50 year olds with BPH

A

25%

37
Q

Treat BPH?

A

5-alpha reductase inhibitor
alpha1 blocker
combo
surgery

38
Q

Young Men UTO

A

Urethral stricture often from trauma

39
Q

PS NERVE

A

pelvic (bladder)

40
Q

Sympathetic Nerve

A

Hypogastric (T10-L2)

detrusor / urethra / bladder neck

41
Q

Motor (Somatic) Nerve

A

Pelvic
pelvic floor
external sphincter

Renal (6 decks)

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