Renal & Urology Flashcards
What is the function of the urinary tract?
To collect urine produced continuously by the kidneys and store it until an appropriate time to release it
Where are the kidneys?
They are retroperitoneal between T11 and L3 their blood supply is the renal arteries which come directly off the aorta at L1 level
how long are the ureters?
25-30cm
What is the path of the ureters?
they run retroperitoneally, over the Psoas muscle and cross the iliac vessels at the pelvic brim to enter the bladder
How is one way movement down the ureter done?
Peristaltic movements direct the urin down and there is the vesicoureteric junction in the bladder that stops the urine going back up to the kidneys
Which nerves are involved inthe bladder and sphincters?
pelvic nerve parasympathetic S2-S4 which is incoluntary, sympathetic nerves hypogastric plexus T11-L2, involuntary. there is somatic nerve the pudendal nerve S2-4 Onuf’s nucleus ant afferent pelvic nerve wich is sensory and
What are the neural controls involved with urinating?
Cortex: voluntary control, Pontine micturation centre and periaqueductal grey; co-ordination of voiding Sacral micturition centre: micutration reflex and Onuf’s nucleus: the guarding reflex
What are the Guarding reflex and micturation reflex?
Guarding to stop innapropriate voiding and micturation is to allow voiding at an appropriate time
When bladder is in storage phase what is happening?
Bladder fills continuously as urine is produced. As the bladder fills it does receptive relaxation to allow proper filling of the bladder.
What happens as the bladder fills more?
afferent pelvic nerves send slow firing signals to the spinal cord and the sympathetic nerves of the hypogastric plexusu stimulate the relaxation of the detrusor and somatic pudendal nerves contracts theurethral sphincter
What happens during voiding of the bladder?
It is an autonomic spinal reflex. The afferent pelvic nerve sends fast signals to the sacral micturation centre and the pelvic paraympathetic nerve stimulates the detrusor to contract and the pudendal nerve isinhibited to relas the external sphincter
What is the Guarding reflex?
Voluntary control of micturation can occur in anatomically and functionally normal adults,the symathetic nervs stimulates detrussor torelax and pudendal nerve stiumulation results in contraction of the external urethral sphincter.
What symptoms are included in lower urinary tract problems?
Urinating frequently, urination at night, Urgency with or without incontincence. Voiding symptoms hesitanc straining poor or intermittent stream and incomplete emptying, dribbling and blood in the uring and no urine
What is BPH?
Benign prostatic hyperplasioa form histological finding
What is BPE?
Penigne prostatic enlargment from digiral rectal examination
What is BOO?
Bladder outlow obstruction, proven by a test
What is LUTS?
Lower urinary tract symptoms, a constellation of symptoms that are not gender or disease specific
How common is Benign prostatic hypertrophy?
82% men 71-80have it
What is benign prostatic hypertrophy/
Increase in epithelial and stromal cell numbers in the paraurethral area of the prostate can be due to increase in cell number or reduction in cell death
What is benign prostatic obstruction?
Dynamic component, alpha1 adrenoreceptor mediated prostatic smooth muscel contraction often from hyperplasia Static component is the increase in volume effect
What is the role of androgens in benign prostatic hyperplasia?
They faciitate it, castration prior puberty or hypogonadism stop BPH from happening
What is involved in a urology history?
What symptoms, storage, voiding problems are, Duration of symptoms, PMH PSH, Drug history Allergies, Symptom scoring
What is international prostate symptom score?
A table used to evaluates prostate sympyoms
What is involved in urology examination?
General exam, abdominal examination, External genitalia, digital rectal examination, focussed neurological examination, urinalysis