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Urinary > Neurological Control Of Micturition > Flashcards

Neurological Control Of Micturition Flashcards

1
Q

What are the roles of the sympathetic and parasympathetic nervous system in micturition?

A

sympathetic - storage S-S
parasympathetic - peeing P-P

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2
Q

What are the internal and external urethral sphincter composed of?

A

internal - smooth muscle
external - skeletal muscle

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3
Q

What is the storage phase of the bladder?

A

The ability of the bladder to increase in volume with no appreciable change in pressure

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4
Q

What is the voiding phase of the bladdder?

A

Contraction of detrusor to enable voiding
(Fluctuations in pressure)

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5
Q

At what volume of urine in the bladder does the voiding phase start?

A

500ml

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6
Q

When is there a sudden increase in pressure n the storage phase on the bladder?

A

> 150ml

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7
Q

Outline the role of the sensory + sympathetic neurones in micturition (storage reflex)

A
  • stretch receptors in the detrusor muscle detect stretch in bladder wall
  • stretch receptors innervated by sensory neuron enter spinal cord at S2-4
  • ascend up to T10-L2 (location of sympathetic)
  • sensory neurones synapse on sympathetic neurones
  • two sympaethic pathways:
    -NA acts on B3 receptors in detrusor muscle > inhibit contraction
    -NA acts on a1 receptors in IUS > contraction
  • storage phase / inhibit micturition
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8
Q

What role does the sympathetic nervous system have on micturition?

A

Inhibitory effect
- NA act on B3 in detrusor muscle > prevent contraction
- NA act on a1 in IUS > contraction

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9
Q

Outline the role of the sensory + somatic motor neurones in micturition (storage cortical control)

A
  • stretch receptors communicate with L centre within brain stem
  • sends axons to somatic motor neurones at pudenal nerve S2-4
  • ACh act on nicotinic receptors in EUS > contraction
  • inhibits micturition
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10
Q

What type of neural control is the external urethral sphincter under?
What neurotransmitter is involved + what receptor?

A

Somatic motor via pudendal nerve S2-4
Acetylcholine to nicotinic receptor

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11
Q

What type of neural control is the internal urethral sphincter under?
What neurotransmitter is involved + what receptor?

A

Sympathetic
Noradrenaline to a1 receptor

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12
Q

What type of neural control is the detrusor muscle under?
What neurotransmitter is involved + what receptor?

A

Sympathetic - inhibitory
Noradrenaline at B3 receptor
.
Parasympathetic - stimulatory
Acetylcholine at M3 receptor

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13
Q

Outline the sensory + parasympathetic neurones in micturition (voiding reflex)

A
  • stretch receptors in detrusor muscle are innervated by sensory neurones
  • enter spinal cord at S2-4
  • synapse to parasympathetic neurones
  • ACh acts on M3 receptors at detruosr muscle > contraction
  • results in micturition
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14
Q

Outline voiding cortical control

A
  • sensory input to M centre from detrusor muscle due to high levels of bladder wall stretch
  • M centre in the brainstem stimulates parasympathetics > contraction
  • paracentral lobules send excitatory + inhibitory influences down onto M centre
  • M centre also inhibits L centre
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15
Q

What occurs in potty training?

A
  • immature connection between M centre + parasympathetics > ‘automatic bladder’
  • maturation of connection occurs during potty training
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16
Q

Why can dementia patients have urinary incontinence?

A

Regulation of Paracentral lobules to M centre lost

17
Q

Why can cauda equina cause incontinence?

A

Damage to S2-4 > damage to pudenal nerve > altered stimulation to EUS

18
Q

Outline the communication between M and L centres

A
  • M centre inhibits L centre when you want to void strongly by switching off pudendal nerve
  • activates parasympathetics > contraction of stress muscle > urination
19
Q

Which major divisions of nervous system innervate the bladder?

A

Sympathetics
Somatic
Parasympathetics

20
Q

What brain centre is response for storage of urine?

A

L centre
- increases sympathetic activity
- inhibition of detrusor muscle contraction
- IUS contracts

21
Q

As the badder fills what happens to intravesical pressure?

A

Initially doesn’t increase much
Rapid increase in pressure >150ml

Urinary (24 decks)

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