The Lower Urinary Tract Flashcards
Once urine leaves the medulla and enters the minor calyx is it modified anymore?
- no
Once urine leaves the medulla and enters the minor calyx it does not get modified anymore, which means that the epithelial tract are impermeable to H2O and electrolyes. What type of epithelial cells line the walls of the urinary tract?
- transitional epithelium
- a type of stratified epithelium
- these cells contract and expand in order to adapt to the degree of distension needed
Once urine leaves the medulla and enters the minor calyx it does not get modified anymore, which means that the epithelial tract are impermeable to H2O and electrolyes. Transitional epithelium, a type of stratified epithelium line the urinary tract and are able to contract and expand in order to adapt to the degree of distension needed. Why are these cells also good if there is a blockage in the kidney?
- they are able to distent and dilate
- accomadates the back up of urne
Once urine leaves the medulla and enters the minor calyx it does not get modified anymore, which means that the epithelial tract are impermeable to H2O and electrolyes. Transitional epithelium, a type of stratified epithelium line the urinary tract and are able to contract and expand in order to adapt to the degree of distension needed. The cells in the renal pelvis then stretch causing dilation and distention to accomadates the back up of urne. This stretch then causes what?
- triggers peristaltic contractions starting at the hilum
- aims to move out of renal pelvic, down ureter and towards the bladder
When urine needs to move down the ureters, there are peristaltic contractions, also known as (vermiculation) similar to GI tract. What are the orientations of smooth muscle that facilitate the process of peristaltic contractions in the ureters?
-
- longitudinal and circular smooth muscle
- create successive peristaltic waves
When urine needs to move down the ureters, there are peristaltic contractions, also known as (vermiculation) similar to GI tract. SUccessive peristaltic waves from longitudinal and circular smooth muscle faciliate the movement of urine. How do curcular and longitudinal muscles work together?
- longitudinal muscle contracts first followed by circular muscle relaxation
- longitudinal muscle then starts to relax allowing a bolus to form followed by circular muscle contraction which pushes against the bolus
In ureters there is a mucosal layer that is lined by transitional epithelium, which impermeable to H2O and electrolytes. What is this mucosa supported by?
- inner longitudinal muscles (L)
- outer circular/spiral muscle (C)
- extra outer layer of longitudinal muscle
When urine needs to be moved through the ureters to the bladder dilation of renal pelvis generates action potential from hilar pacemaker cells. The number of action potentials can be acted on by the autonomic nervous system. What do the parasympathetic and sympathetic nervous system do to the number of action potentials for peristalsis?
- parasympathetic = enhances action potentials
- sympathetic = inhibits action potentials
Does the bladder attach to the anterior or posterior abdominal wall?
- posterior
What is the name of where the ureters enter the bladder and is this a two way junction or one way junction for urine direction?
- vesico-ureteric junction
- small flaps of mucosa cover these openings and act as valves that allow urine to enter the bladder but prevent it from leaving
Where is the fundus and neck of the bladder?
- fundus = the body of the bladder
- neck = where the urether leaves the bladder
What is the name of the outer muscle layer of the bladder and does it have the same muscle origentation all the way around?
- called Detrusor Muscle layer
- composed of longitudinal and circular muscles
What type of cell lines the inner mucosa of the bladder and why?
- transitional epithelial cells
- these cells can be folder up to reduce the bladder size, creating rugae
- allow for dilation and stretching
There is a triangle shape that is formed from the openings of ureters and entrance to urethra. What is this called?
- trigone
There is a triangle shape that is formed from the openings of ureters and entrance to urethra called the trigone. What are the 2 main functions of the trigone?
1 - acts as a funnel
2 - contains stretch receptors. Once stretched past a certain degress they signal the need to pass urine
What is the rough capacity of the bladder and how is it activated to release?
- 1L
- parasympatheitc activity stiumlates contraction of the bladder to release urine
To ensure control of the bladder and its urine content there are 2 urethal sphincters. What are these called working from inside to outside the bladder?
1 -internal urethral sphincter
2 - external uretheral sphincter
To ensure control of the bladder and its urine content there are 2 urethal sphincters, the internal and external uretheral sphincters. What is the composition and role of the internal uretheral sphincter?
- band of smooth muscle (detrusor) muscle
- normal tone keeps neck of bladder and urethra free of urine
To ensure control of the bladder and its urine content there are 2 urethal sphincters, the internal and external uretheral sphincters. What is the composition and role of the external uretheral sphincter?
- composed of circular band of skeletal muscle where urethra passes through urogenital diaphragm
- acts as a valve with resting muscle tone
- voluntary relaxation permits micturition (action of urinating)
To ensure control of the bladder and its urine content there are 2 urethal sphincters, the internal and external uretheral sphincters. Out of the internal and external uretheral sphincter, which is under voluntary and involuntary control?
- internal uretheral sphincters = involuntary
- external uretheral sphincters = voluntary
In females, the urethra is located where?
- between clitoris and vagina
In females, the urethra is located where between the clitoris and the vagina. It is much shorter than the urethra in males, making females more susceptibel to what?
- UTIs
In females, the urethra is located between the clitoris and the vagina. It is much shorter than the urethra in males, making females more susceptibel to UTIs. In addition the external sphincter is not as well developed in females. What can this cause following pregnancy or trauma?
- incontinence (loss of bladder control)
In males the urethra has to pass through what gland and another site?
- passes through the prostate
- then passes through the uro-genital diaphragm and into the penis
Why are men less likley to contract a UTI than women
- longer urethra
In 50% of men over 60 years what can happen to the prostate?
- prostate gland enlarges
- hypertrophy of detrusor muscle
- may require surgical or hormone treatment
In 50% of men over 60 years the prostate gland enlarges due to hypertrophy of detrusor muscles, which may require surgical or hormone treatment. What else is, in relation to the prostate is common in older men?
- prostate cancer
one of the commonest cancers with mortality rate of 3%
Micturation (passing of urine) is a 2 stage process. What are the 2 stages?
1 - bladder fills until pressure within bladder reaches a threshold
2 - “micturition reflex” occurs presenting as a conscious desire to urinate
Micturation (passing of urine) is a 2 stage process. Where the micturation reflex triggers the need to urinate. This is an autonomic reflex controlled by higher centres in the brain, but what 2 things can happeb following this higher centre stimulation in the brain?
1 - inhibited by higher centres in the brain, causing contraction of external sphincters
2- facilitated by cortical centres in the brain that initiate the micturition reflex and relax the external sphincter, causing the internal sphincter to relax at the same time and urination occurs
In the figure belowe the dashed lines denote pressure peaks (micturition contractions) that are periodic reflex contractions of short duration which occur as the bladder is filling. At this point does micturation have to occur?
- no
- contractions tell you bladder is filling
In the figure belowe the red solid line denotes the normal intrinsic tone of the detrusor muscles of the bladder. As the red solid line increases the pressure inside the bladder increases and the number and intensity of the micturation contrations increases, what then follows?
- micturation (passing of urine)
The intravesicle pressure increases in the bladder as it fills with urine. During normal hydratiom, how quickly does the bladder fill?
- 1ml/min
The bladder is innervated by the sympathetic nerves. Which nerve provides this innervation, and where does this originate from in the sympathetic trunk?
- hypogastric nerve
- T12-L3
The bladder is innervated by the sympathetic nerves, specifically the hypogastric nerve which originates from the sympathetic chain at T12-L3. Does this provide voluntary or involuntary control and what effect does this have on micturation?
- involuntary control
- inhibits micturation (dont need to urinate in fight or flight)