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Urinary > Session 8 > Flashcards

Session 8 Flashcards

1
Q

Define Micturation

A

To want to pass urine (Controlled entirely by the spinal cord)

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2
Q

Define Detruser

A

To push down

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3
Q

What controls the Urine storage phase?

A

Neurones of the sympathetic system (Root values L1 & L2)

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4
Q

What controls the bladder voiding phase?

A

Neurones of the parasympathetic system (Root values S2, S3 & S4)

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5
Q

What are the 2 urethral sphincters?

A

Internal and External

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6
Q

What type of sphincter is the Internal urethral sphincter?

A

A physiological one - It is a passive valve made by a specific tissue arrangement. As the bladder fills, it forces the valve to close

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7
Q

What supplies the body of the urinary bladder?

A 
The ANS (Parasympathetic & Sympathetic)
Not under voluntary control
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8
Q

What supplies the External urethral sphincter?

A

The Somatic nervous system

Under voluntary control (From cerebral cortex via the spinal cord)

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9
Q

What is important to remember about the neural control of the urinary bladder?

A

It is a balance between somatic and autonomic divisions of the nervous system

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10
Q

What is autonomic dysreflexia?

A

The body loses control of the bladder

It fills and can cause issues

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11
Q

What is the histiological properties of the Detrusor muscle of the urinary bladder?

A

Smooth muscle with no peristaltic activity
Lined with transitional epithelium - Non secretory
It contracts and relaxes wholly

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12
Q

What is the significance of the Detrusor muscle being able to contract and relax wholly?

A

When it starts emptying, it empty completely

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13
Q

What are the 2 general functions of the urinary bladder?

A

Phase I - Temporary storage of urine

Phase II - Expulsion of urine

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14
Q

What can the epithelium of the urinary bladder do during Phase I?

A

Can temporarily absorb some water, but not for long because they do not want to absorb it into the body

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15
Q

What is Phase I also known as?

A

The Continence phase

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16
Q

What is Phase II also known as?

A

The Micturition phase

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17
Q

What controls the Continence phase?

A

A dedicated set of neurones called continence neurones

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18
Q

What may happen if you damage the continence neurones?

A

The bladder can no longer store urine which leads to reduced bladder capacity and incontinence (Many types of incontinence)

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19
Q

What will happen if you damage the neurones controlling Micturition? (Different set to continence neurones)

A

Cannot voluntarily pass urine so leads to urinary retention. Urine is only passed when the urinary bladder is overflowing

20
Q

What is it called when urine is only passed due to the urinary bladder overflowing?

A

Overflow incontinence. Need to catheterise

21
Q

What is it called when a patient cannot void their urinary bladder?

A

Urinary retention. Need to catheterise

22
Q

What does the external uretheral sphincter do when the bladder relaxes?

A

It closes/contracts

23
Q

What does the external urethral sphincter do when the bladder contracts?

A

It relaxes

24
Q

What is the name for disturbances to the synchrony of detruser muscle and external urethral sphincter?

A

Detrusor - Sphincter dyssenergia (Leads to a build up of urinary pressure as the bladder cannot empty properly

25
Q

What are the neural apparatus involved in the Continence phase called?

A

Continence circuits (In the spinal cord) and Continence centres (In the brain)

26
Q

Where are Pontine centres?

A

In the brain stem

27
Q

What are Pontine centres?

A

Neuronal centres that rely information from the Cerebral cortex to sympathetic nuclei in the spinal cord

28
Q

What are Pontine Continence circuits?

A

Bilateral outputs from the Pons (In the brain stem)

29
Q

What do Pontine Continence circuits control?

A

Silence electrical activity of the Detrusor muscle
Relaxation of Detrusor muscle (Beta 3 in body and fundus of urinary bladder)
Increase urethral sphincter pressure (alpha adrenoceptors in neck of urinary bladder)
Encourage storage of urine

30
Q

What 2 nervous systems are in balance for spinal urinary continence?

A

Sympathetic nervous system

Somatic nervous system

31
Q

What does the Sympathetic nervous system control in the urinary bladder?

A

Relaxed Detrusor muscle via Beta 3 receptors

Internal urethral sphincter constriction leading to neck closure via alpha adrenoceptors

32
Q

What does the somatic nervous system control in the urinary bladder?

A

Activates closure of the external urethral sphincter via Ach action at the neuromuscular junction

33
Q

What root values of the sympathetic nervous system supply the urinary bladder?

A

T10/T12-L2 (Thoracico-lumbar cord)

34
Q

What root values of the somatic nervous system supply the urinary bladder?

A

S2-S4 (Onuf’s nucleus)

35
Q

What property of the urinary bladder wall increases its storage?

A

There are rugae in the walls so they can distend as the urinary bladder fills (Causes the internal urethral sphincter to close and for intravesical pressure to remain fairly constant)

36
Q

What are the effects of a lesion on a continence circuit?

A 
Cannot store urine
Decreased bladder capacity
Excessive detrusor muscle activity
Premature voiding
Relaxation of urethra
Incontinence
37
Q

How does the urinary bladder sense it needs to empty?

A

Afferent nerves (Parasymapthetic origin) sit in the wall of the urinary bladder with stretch receptors. Mild pain sensation that is localised (Do NOT have referred pain)

38
Q

What controls the Voiding phase of the urinary bladder?

A

Micturition centres of the brain that activate micturition centres of the spinal cord (Voiding circuits arising from the pons) Parasympathetic neurones of the sacral division

39
Q

What do Voiding circuits cause?

A

Contraction of the detrusor muscle
Increase in pressure
Relaxation of the internal urethral sphincter
Voluntary relaxation of the external urethral sphincter
Expulsion of urine

40
Q

What causes the External urethral sphincter to relax?

A

Cerebral cortex (Somatic) Spinal root values S2-S4 cause relaxation

41
Q

What increases Detrusor activity?

A

The parasympathetic division of the ANS, root values S2-S4

42
Q

What is the nerve supply of the bladder?

A

Purely autonomic.
No motor or sensory representation of the urinary bladder in the motor cortex (Meaning sensation and voiding do not need to be under conscious control)

43
Q

What is the External urethral sphincter?

A

Muscles of the pelvic floor overlay to form a sphincter.

44
Q

What nerve supplies the External urethral sphincter?

A

Perineal branch of the Pudendal nerve. Root values S2-S4.

45
Q

What is Stress urinary incontinence?

A

Fine until sneeze or cough when get involuntary leakage

46
Q

What is Urge urinary incontinence?

A

Urgency to go to the toilet

Urinary (14 decks)

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