Pathology of the adrenal glands and endocrine pancreas

Question 1

what are the effects of severe spina bifida

Answer 1

lower motor neurone lesions
paralysis
loss of sensation, and reflexes distal to the abnormality

Question 2

what are the effects of spina bifida in the neonate

Answer 2

meningitis in open lesions
hydrocephalus is very common due to interruption of the circulation of CSF

Shunts may become infected or blocked

Question 3

what conditions are associated with spina bifida

Answer 3

renal
sphinter function
intellectual impairments
musculoskeletal problems

Question 4

how can spina bifida be diagnosed antenatally

Answer 4

ultrasound (16-18 weeks)

alpha fetoprotein raised
amniocentesis

Question 5

what are the problems with antenatal diagnosis

Answer 5

not everyone attends antenatal care
some mothers attend after the abortion limit
culture/religion may prevent abortion

Question 6

what are the musculoskeletal problems associated with spina bifida

Answer 6

LMN weakness/paralysis
difficulty walking
spinal deformity 
osteoporosis
skin ulceration 
paralytic feet deformaties- shoe problems and ulcers

Question 7

what are the effects of a flexed knee gait in L4 lesion

Answer 7

paralysed calf muscles result in excess dorsiflexion 
muscle fatigue
energy inefficient gait
knee pain
low muscle strength
may need a wheel chair later 
can drive

Question 8

what are charcot joints

Answer 8

loss of sensation and proprioception in the joint can damage the joint

Question 9

what are the bladder consequences in spina bifida

Answer 9

overflow incontinence
dribbling
inadequate bladder drainage
recurrent infections
renal function monitoring

Question 10

what is a neurogenic bladder

Answer 10

incomplete bladder emptying leads to back pressure on ureters and eventual renal parenchymal damage and failure

Question 11

what is the nerve supply of the urinary sphincter

Answer 11

s2-4

Question 12

what can be a good treatment for urinary incontinence

Answer 12

clean intermittent
catherterisation

may have urinary diversion into a bag

Question 13

how can spina bifida affect the bowel

Answer 13

faecal incontinence
paralysis of external anal sphinter
cannot feel a full rectum
weak perineal muscles

Question 14

how can faecal incontinence be treated

Answer 14

enema
constipation- laxatives or manual evacuation
surgical diversion

Question 15

how does spina bifida affect sex and reproduction

Answer 15

Libido may be normal
Sensation absent (S2-4)
Erections may be possible due to spinal reflex
Fertility females normal
males usually sterile
Menstruation may be a further social difficulty