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Urinary > Micturition > Flashcards

Micturition Flashcards

1
Q

What is the gold standard (non-clinical) for measuring GFR? Why?

A

Inulin clearance

Because inulin is not reabsorbed so whatever is filtered will be excreted.

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2
Q

What is the “normal” GFR?

A

125ml/min

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3
Q

How quickly does GFR decrease?

A

1ml/min/ year after 30

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4
Q

What is routinely used in order to estimate GFR?

A

Creatinine clearance

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5
Q

Why can creatinine clearance not be the best measure of GFR?

A

Not a linear relationship btw GFR & creatinine (cannot detect small changes)

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6
Q

What factors affect serum creatinine?

A

Muscle mass
Dietary intake (vegetarians & supplements)
Drugs

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7
Q

What will glucose have a clearance of? Why?

A

0

Because all reabsorbed

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8
Q

What is clearance of urea?

A

Less than inulin because some urea is reabsorbed

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9
Q

What is used to measure renal plasma flow? (RPF)

A

PAH (paraaminohippuric acid)

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10
Q

What is the normal renal plasma flow?

A

660mls/min

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11
Q

What will be the clearance of penicillin compared to inulin?

A

Higher as it is filtered & secreted

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12
Q

How does urine flow through ureters to bladder?

A

Smooth muscle peristaltic contractions

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13
Q

What are the different ways muscles are arranged in the bladder?

A

Longitudinal
Circular
Spiral

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14
Q

What type of muscle is detrusor muscle?

A

Smooth muscle

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15
Q

What is a false sphincter?

A

Internal urethral sphincter acts as a spinster when smooth muscle relaxed

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16
Q

What is a true sphincter?

A

External urethral sphincter - under voluntary control

17
Q

Where does the bladder lie posterior to?

A

Pbic symphysis

18
Q

What epithelium is the bladder composed of?

A

Transitional epithelium

19
Q

Where do the ureters open into?

A

Trigone of bladder

20
Q

What are the openings called where the ureters enter the bladder?

A

Vesicoureteric openings

21
Q

As volume in the bladder increases what happens to pressure?

A

Increased intravesical pressure

22
Q

Which nerves are responsible for contraction of detrusor muscle?

A

S2-4 parasympathetic

23
Q

Which nerves inhibit smooth muscle contraction at bladder?

A

Sympathetic (hypogastric) nerves

24
Q

What is the main function of sympathetic innervation at the bladder?

A

Urethral contraction to prevent semen moving into bladder on ejaculation

25
Q

Which nerves innervate the skeletal muscle of the external urethral sphincter keeping it closed?

A

Pudental nerves (S2-4)

26
Q

As sensory afferents increase firing from bladder with increased stretch what do interneurons do?

A

Increase parasympathetic outflow

Decrease sympathetic outflow

Inhibition of motorneurones to external sphincter

Pathways to sensory cortex

27
Q

What can the micturition reflex be compared to?

A

Spinal reflex

28
Q

At what volume will the bladder initiate micturition reflex?

A

300-350mls

29
Q

How can we delay micturition from reflex voiding?

A

Delayed by descending pathways which inhibit parasympathetic outflow

30
Q

In voluntary initiation of voiding, what will be observed?

A

Descending pathways will stimulate parasympathetic outflow & inhibit somatic motto neurones to external sphincter

31
Q

What other muscles are involved in continence?

A

Pelvic floor muscles

32
Q

What are the 3 major types of neuronal lesion which lead to micturition abnormalities?

A

Afferent nerve interruption
Interruption of both afferent & efferent
Interruption of facilitatory & inhibitory descending pathways

33
Q

Ux is short for?

A

Urine concentration

34
Q

V is short for?

A

Urine flow rate

35
Q

Px is short for?

A

Plasma concentration

36
Q

What is the equation which defines GFR?

A

Plasma clearance (C) = Ux V/Px

37
Q

How much urine should be produced / day?

A

750-2500mls

Urinary (17 decks)

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