module 12 lower urinary tract Flashcards
lower urinary tract
post-kidney to urethra
Micturition
reflex and voluntary
mediated by pons, gravity, peristalsis, and nervous system
structures of lower urinary tract
ureters
bladder
urethra
urinary sphincters
ureters
collect urine from renal pelvis and transport to bladder
bladder
stores and expels urine to urethra
urethra
urine exits the body
Pons and micturition
relaxation of the interal sphincter and contraction of the bladder to enable urination
cerebral cortex and micturition
primarily inhibits via conscious control of the external sphincter
Bladder innervation
sympathetic nerves L1-2, allow relaxation and filling
parasympathetic nerves S2-4, bladder contraction and relaxation of the internal sphincter to initiate bladder emptying. Stretch sense
internal sphincter
bladder is prevented from emptying until the pressure in the body of the bladder rises about a specific threshold.
- detrusor muscle
external sphincter
allows voluntary emptying of the bladder or the prevention of urination.
- ring of skeletal muscle
voiding
detrusor muscle to contract and urethral sphincters to relax
continent
coordinate urination at a suitable location and time
residual urine
less than 50-100 mL following voiding
Urethritis
inflammation of the urethra
infection from bladder, STD, or external factors
- cath, poor hygeine, dec. estrogen
Urethritis s/s
pain burning incontinence urethral discharge abscess -Men: epididymitis, prostatitis
cystitis
inflammation of the bladder lining infection; bacterial, fungal, or parasitic chemical irritants stones trauma > women/girls
risk factors for cystitis
urinary stasis foreign bodies anatomic factors dec. immune response preg dec. intake obstruction cath's dec. estrogen spermicidal agens sex recurrent UTI
cystitis s/s
frequency urgency dysuria pain pink or cloudy UA PEDS - fever - irritable - poor feeding - vomiting - diarrhea - lethargy GERIATRIC - delirium - incontinence
Lower urinary tract urolithiasis
stones forming anywhere in the urinary tract
may originate in kidney, bladder, or ureters
supersaturation and obstruction
insolubility fo the urine by stone forming constituents
- Ca
- oxalate
- phosphate
- uric acid
ureteral calculi
usually small and pass fine
large stone -> obstruction
s/s of ureteral calculi
pain, radiates hematuria inc. HR inc. RR sweating N/V
bladder calculi 3 categories
migrant
primary
secondary
migrant bladder calculi
from upper tract
primary bladder calculi
formation occurs in bladder without underlying pathology
secondary bladder calculi
associated with conditions
- bladder outlet obstruction: BPH
- neurogenic bladder r/t spinal cord injury
- chronic bladder infections
- foreign bodies
bladder calculi s/s
dysuria
suprapubic pain
urinary hesitancy
hematuria
hydronephrosis
marked dilation of the pelvis and calyces and thinning of the renal parenchyma
acute hydronephrosis
usually partial obstruction
oliguria
chronic hydronephrosis
oliguria
anuria
elevated pressure from obstruction -> damage -> ARF
chronic hydronephrosis s/s
vague intestinal symptoms
N/V
abdominal pain
void dysfunction secondary to
- disorder os lower urinary tract
- pathologies affecting central, autonomic, and peripheral nervous systems
- control of micturition
incontinence
involuntary urine loss
never normal
urge incontinence
involuntary sudden leakage of urine along with or immediately following the sensation of a need to urinate
- overactive detrusor muscle
- idiopathic, bladder infection, radiation therapy, tumors/stones, CNS damage
stress incontinence
occurs when urine is involuntary lost with inc. in intraabdominal pressure
- precipitated by effort or exertion
- weakened pelvic muscles or intrinsic urethral sphincter deficiency
overactive bladder syndrome
inc. daytime frequency and nocturia, though not necessarily with incontinence.
neurogenic bladder
broad classification of voiding dysfunction
- cause is a pathology that produces a disruption of nervous communication governing micturition
- spinal injury
- MS
- Parkinsons
- Storke
- Neuropathy of DM
overflow incontinence
bladder becomes so full that it leaks
- obstruction of the urethra
- underactive/inactive detrusor muscle
functional incontinence
r/t physical or environmental limitation resulting in an inability to access a toilet in time
enuresis
intermittent incontinence while asleep
inappropriate wetting of clothing/bedding
types of enuresis
primary
secondary
monosymptomatic nocturanal enuresis
nonmonosymptomatic nocturnal enuresis
primary enuresis
nocturnal enuresis
secondary enuresis
develops after a period of at least 6 mo. of dryness
monosymptomatic nocturnal enuresis
nocturnal incontinence but no other signs of lower urinary tract malfunction
nonmonosymptomatic nocturnal enuresis
urgency, frequency, or daytime incontinence with night incontinence
enuresis patho
deficiency in ADH (vasopressin)
nocturnal overactivity of the detrusor muscle
immature or abnormal arousal mechanisms
familial pattern
