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NME > The Lower Urinary Tract > Flashcards

The Lower Urinary Tract Flashcards

1
Q

Female Pelvis

A

insert diagram

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2
Q

Where does the ureter enter the bladder?

A

posterolaterally

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3
Q

Male Pelvis

A

insert diagram

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4
Q

mALE pELVIS

A

insert diagram

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5
Q

Posterior Relations of the bladder in males:

A
  • ductus deferens (runs through the
    inguinal canal, below bladder and
    attaches to seminal vesicles)
  • seminal vesicles (either side)
    (connects to the prostate via)
  • ejaculatory ducts
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6
Q

Vesicouterine pouch is a

A

reflection of peritoneum

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7
Q

The uterus lies in an —— position

A

anteverted
(tips forward at the cervix)

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8
Q

How full does the bladder have to be to palpable and where does it protrude?

A
  • 300ml
  • anterior to the pubic symphysis
  • strips the peritoneum of the
    anterior bladder wall
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9
Q

What lies inferior to the bladder?

A

Levator ani (pelvic floor muscles)

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10
Q

Internal Bladder Anatomy

A

insert slide

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11
Q

Why does urine generally not reflux up the ureter?

A
  • no valve
  • inserts diagonally through detrusor
    muscle wall
  • as bladder fills, pressure rises,
    muscle will close the ureter opening
    hence urine in distal ureter can not
    reflux up
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12
Q

Trigone of bladder embryological origin:

A

mesoderm

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13
Q

What is the trigone?

A
  • smooth triagnular region of bladder
  • formed by two ureteric orifices and internal urethral orifice
  • very sensitive to expansion, once
    stretch signal to brain to need to
    empty
  • signals become stronger as bladder
    continues to fill
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14
Q

Bladder embryological origin:

A

endoderm (apart from trigone)

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15
Q

Where is the ureter in relation to uterine arteries?

A
  • inferior
  • bridge over water
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16
Q

Where is a potential site of ureteric injury in a hysterctomy?

A

Where the ureter runs under the uterine artery and vein

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17
Q

Female Pelvis

A

insert diagrams

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18
Q

Bladder mucosa is called

A

urithelium

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19
Q

bladder wall and epithelium

A

insert

20
Q

Transitional cell epithelium is impermeable to

A

water and electrolytes due to a highly keratinised cellular membrane synthesised in the Golgi

21
Q

Why is transitional cell epithelium impermeable?

A

importance in acting as an osmotic barrier between the contents of the urinary tract and surrounding organs/tissues

22
Q

What is the most impermeable membrane in the mammalian body?

A

Transitional cell membrane (bladder)

23
Q

Detrusor Muscle:

A
  • longitudinal and circular smooth
    muscle bundles
  • actin and myosin filaments aligned
    loosely and anchored to dense
    bodies
  • contraction shortens and thins the
    whole cell
  • muscarinic M2&3 cholinergic
    receptors
  • muscle cells connected by gap
    junctions
24
Q

Bladder Innervation: Sympathetic:

A
  • L2 nerve root
  • sympathetic ganglia
  • hypogastric plexus
  • Splanchnics: Lesser, Least, Lumbar
  • relaxation of bladder (not empty)
25
Q

Bladder Innervation: Parasympathetic:

A
  • S2-4 nerve roots
  • Pelvic Splanchnic nerves
  • bladder contraction: emptying
26
Q

Bladder Innervation: Somatic Supply:

A
  • S2-4
  • Pudendal Nerve: urethral sphincter
27
Q

Bladder Innervation:

A

insert diagram

28
Q

Detrusor muscle cell alignment vs skeletal muscle

A

not sheets
muscle bundles

29
Q

Bladder Receptors:

A

insert diagram ***

30
Q

Tablets use to inhibit bladder contraction act on M3 receptors so common side affect is

A

DRY MOUTH
inhibition of salivary glands
also have M3 receptors

31
Q

Bladder Complaince:

A

bladder relaxes as it fills to allow storage

overdistension leads to renal retention
insert

32
Q

Adaptations of Bladder Summary

A

insert slide

33
Q

Guarding Reflex:

A
  • neck of bladder
  • bladder should empty to 0
  • resting tone in external sphincter
  • as the bladder fills, reflex increases
    tone in external sphincter and
    bladder muscle relaxes (no emptying)
34
Q

What does the micturition reflex allow?

A

Bladder emptying

35
Q

Micturition Reflex:

A
  • once bladder reaches certain
    volume and there is no cerebral
    control of the bladder
  • the body of the bladder will
    contract
  • neck of bladder, urethra and
    sphincters will relax
  • bladder will empty
36
Q

Where is the micturition reflex mediated?

A

Spinal cord

37
Q

Micturition reflex only triggered in unconscious patients.

True or False?

A

True

38
Q

Bladder Filling Phase

A
  • guarding reflex: mediated by symp
    and parasymp: PONTINE CENTER
  • orange = symp
  • blue = para

insert diagram

39
Q

Voiding Phase:

A

insert
(box 2 not needed)

40
Q

Types of Incontinence:

A

insert

41
Q

Incontinence:

A

insert

42
Q

Mechanisms of Drugs on the Bladder:

A

insert diagram

43
Q

Urge Incontinence Treatments: Diagram:

A

Insert
- block M3 receptor: anticholinergics:
dry mouth, not storing urine better
because drinking more
- B3 agonist: reduce contraction
- botox detrusor muscle: reduce
contraction: overdose may need
catheterise

44
Q

Stress Incontinence: Treatment:

A

Insert
- mostly non-drug treatment
- surgery: more support to urethra
- nicotine agonist: fluoxetine: external
urethral sphincter: increase tone

45
Q

Urinary Retention:

A
  • BPH: Benign Prostatic hyperplasia,
    enlarges, often bladder can
    overcome
  • can lead to urine retention
  • measured using a flow test
  • most empty in 30secs
  • can result in thickening of the
    bladder wall
  • can result in diverticula
    (outpouches) risk factor for stones
  • can transmit to high pressures in
    ureter and kidney (hydronephrosis)
46
Q

Urinary Retention:

A

insert slide

47
Q

Urinary Retention: Treatment:

A

insert slide
- alpha blocker: relaxation of neck
- S alpha reductase inhibitor: works
on BPH, convert to testesterone to
dihydrotestosterone blocked so
reduce growth factors

NME (52 decks)

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