Neuro And Micturition Flashcards
Pelvic nerve?
S1-3
PSNS to bladder—urinate
Ach, muscarinic
Hypogastric nerve?
L1-4 dogs, L2-5 cats
SNS—store urine
Nor-adrenaline, beta 3 receptors in bladder, alpha 1 receptors in urethra
Pudental nerve?
S1-3
Somatic to external urethral sphincter
Voluntary
Ach, nicotinic
Passive phase—filling
L1-4 (SNS)—hypogastric
Beta receptors in bladder are activated—allow stretching
Alpha 1 receptros are activated (trigone + prox urethra)
Block PSNS flow
Active phase—voiding
Reflex: stretch receptors —> pelvic n. —> spinal cord —> brain stem —> PSNS outflow (S1-3)
Contraction of bladder wall—mm fibers contract
Pudental n is inhibited, dec urethral sphincter tone (can be over-ridden by cerebrum)
What are the characteristics of an UMN bladder?
Detrusor areflexia, sphincter hyperreflexia
Small bladder —> large distended bladder
DIFFICULT TO EXPRESS
How do you tx an UMN bladder?
Banclofen (antispasmodic)
What are the characteristics of a LMN bladder?
Detrusor areflexia, sphincer areflexia
Large bladder
EASILY EXPRESSED
Constant leaking
How do you tx a LMN bladder?
Bethanecol
Express 3-4x/day
What is detrusor-sphincter dyssenergia?
Detrusor contracts + sphincter spasms
How do you tx detrusor-sphincter dyssynergia?
Phenoxybenzamine (alpha-andrenergic blocker)
What is dysautonomia?
All ANS signs. Mainly GI + <3 problems.
Cats
Poor px
What is detrusor atony?
From overfill. Obstruciton. Large flaccid bladder.
How do you tx detrusor atony?
Manually express
What is urge incontinence/detrusor instability/detrusor hyperreflexia?
Contraction during urine storage
Dec detrusor compliance (cystometrography)
Pollakiuria, stranguria, dysuria