Physiology - Control of micturition Flashcards
micturition
the process by which the bladder is emptied when it becomes full
what type of spinal reflexes are stimulated by bladder filling
a.somatic
b.autonomic
c.central
b.autonomic
(parasympathetic and sympathetic)
what type of muscle is the internal urethral sphincter made up of
a.smooth
b.skeletal
a.smooth
involuntary action
what type of muscle is the external urethral sphincter made up of?
a.smooth
b.skeletal
b.skeletal
voluntary action
how many layers make up the bladder wall
a.1
b.2
c.3
d.4
d.4
mucosa
submucosa
detrusor
serosa
what type of epithelium is found on the bladder mucosa
a.stratified squamous
b.simple columnar
c.simple cuboidal
d. transitional
e.pseudostratified columnar
d. transitional
allows for stretch
which layer of the bladder wall is a thin layer of CT , containing nerves and ICCs
a.mucosa
b.submucosa
c.detrusor
d.serosa
b.submucosa
what are the 2 roles of ICCs found in the detrusor
interact with nerves
interact with smooth muscle to imitate contraction
which 3 nerve bundles supply the bladder
pelvic
hypogastric
pudendal
sensory afferents in alll bundles
Which nerves bundles give efferent nerves to the detrusor?
a.pelvic and hypogastric
b.pelvic and pudendal
c.hypogastric and pudendal
d.sympathetic and parasympathetic
a.pelvic and hypogastric
which nerve bundle is made up of parasympathetic efferent fibres from the sacral spinal cord (s2 and s4)
a.pelvic
b.hypogastric
c.pudendal
a.pelvic
from which part of the spinal cord do the pelvic nerves originate
a.sacral
b.lumbar
c.cervical
d.thoracic
a.sacral
s2 and s4
which nerve bundle is made up of sympathetic efferent fibres from the lumbar spinal cord (t11 - s2)
a.pelvic
b.hypogastric
c.pudendal
b.hypogastric
what stimulus stimulates the pelvic efferents to act on the detrusor
a.bladder stretch
b.internal sphincter pressure
a.bladder stretch
parasympathetic pelvic nerves are excitatory
so detrusor contracts
voiding
what stimulus stimulates the hypogastric efferents to act on the detrusor
a.bladder stretch
b.internal sphincter pressure
b.internal sphincter pressure
sympathetic hypogastric nerves are inhibitory
so detrusor relaxes
filling
what effect does pelvic nerve stimulation have on the detrusor
a.contraction
b.relaxation
a. contraction
pelvic nerves are parasympathetic so are excitatory to smooth muscle
contraction and voiding
what effect does hypogastric nerve stimulation have on the detrusor
a.contraction
b.relaxation
b.relaxation
hypogastric nerves are sympathetic so are inhibitory to smooth muscle
relaxation and filling
which efferents innervate the internal urethral sphincter
a.hypogastric
b.pelvic
c. pudendal
a.hypogastric
sympathetic efferents from lumbar spinal cord
noradrenaline
contracts the smooth muscle
filling
which efferents innervate the external urethral sphincter
a.hypogastric
b.pelvic
c. pudendal
c. pudendal
somatic efferents
signals coming down from brain at all time
what type of efferents make up the pudendal nerves that supply the external urethral sphincter
a.sympathetic
b.parasympathetic
c. somatic
c. somatic
signals from brain and PONS to bladder external sphincter
Act contracts this skeletal muscle (voluntary control)
which reflex arc is stimulated by stretch on the bladder wall
a.parasympathetic
b.sympathetic
c.somatic
a.parasympathetic
causes detrusor contraction and voiding as soon as stretch is detected
parasympathetic nerves also synapse to pons allowing conscious control (inhibits micturition reflex)
which reflex arc is stimulated by pressure on the internal sphincter
a.parasympathetic
b.sympathetic
c.somatic
b.sympathetic
relaxes detrusor and contracts internal sphincter
which nerves are activated by the PONS to contract the external sphincter
a.parasympathetic
b.sympathetic
c.somatic
c.somatic
pudendal nerves
When the bladder signals to the PONS it is nearly full the PONS pauses its inhibition of the parasympathetic reflex arc in order for voiding to occur. Which nerves are inhibited by the PONS causing relaxation of the internal sphincter
a.parasympathetic
b.sympathetic
c.somatic
b.sympathetic
stopping of which signals by the PONS causes the external urethral sphincter to relax in order for voiding to occur
a.parasympathetic
b.sympathetic
c.somatic
c.somatic
what are the 4 types of incontinence
stress
urge (detrusor over activity)
overflow
neurogenic
patient has increased frequency snd urgency of urination, following frequent UTIs patient also has diabetes and drinks 5 cups of coffee per day . which type of incontinence would be most likely
a.stress
b.urge
c.overflow
d.neurogenic
b.urge
patient has increased frequency snd urgency of urination, following frequent UTIs patient also has diabetes and drinks 5 cups of coffee per day . which treatment would be most appropriate
a.bladder training and anti muscarinics
b.pelvic muscle exercises, weight loss and surgery
c.M3 agonists, catheterisation
d.catheterization, botox, capsaicin
a.bladder training and anti muscarinics
urge incontinence
patient has bladder leakage upon coughing and sneezing and is a mother to 3 children . which treatment would be most appropriate
a.bladder training and anti muscarinics
b.pelvic muscle exercises, weight loss and surgery
c.M3 agonists, catheterisation
d.catheterization, botox, capsaicin
b.pelvic muscle exercises, weight loss and surgery
stress incontinence
patient has bladder leakage upon coughing and sneezing and is a mother to 3 childrenwhich type of incontinence would be most likely
a.stress
b.urge
c.overflow
d.neurogenic
a.stress
external pressure on bladder / multiple childbirths
patient has a large dilated bladder which does not empty after recently giving birth which type of incontinence would be most likely
a.stress
b.urge
c.overflow
d.neurogenic
c.overflow
sensory nerve disruption
chronic obstruction of the bladder
patient has incontinence and large dilated bladder which does not empty after recently giving birth . which treatment most appropriate
a.bladder training and anti muscarinics
b.pelvic muscle exercises, weight loss and surgery
c.M3 agonists, catheterisation
d.catheterization, botox, capsaicin
c.M3 agonists, catheterisation
patient has incontinence following a spinal cord injury causing involuntary voiding . which treatment most appropriate
a.bladder training and anti muscarinics
b.pelvic muscle exercises, weight loss and surgery
c.M3 agonists, catheterisation
d.catheterization, botox, capsaicin
d.catheterization, botox, capsaicin
neurogenic incontinence
patient has incontinence following a spinal cord injury causing involuntary voiding which type of incontinence would be most likely
a.stress
b.urge
c.overflow
d.neurogenic
d.neurogenic
