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Regional Anatomy - Sem 1 > The Neural Control of Micturition > Flashcards

The Neural Control of Micturition Flashcards

1
Q

Define micturition

A
  • desire to pass urine
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2
Q

Define detrusor

A
  • To push (something) down
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3
Q

Define reflex

A

An unlearned, automatic, repeatable response to a specific stimulus that requires the brain to be intact

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4
Q

What are the 2 classes of motor pools required to make movement across a joint

A
  • Extensor motor pool
  • Flexor motor pool
  • Reciprocally connected by reflex neural circuits
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5
Q

What are the 2 ONLY states of the bladder

A
  • Storing urine
  • Voiding urine
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6
Q

Describe what type of organ the bladder is

A
  • An autonomic effector muscle organ without its own inherent activity
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7
Q

Describe the general anatomy of the bladder

A
  • Hollow muscle organ - derives from the hindgut.
  • Midline structure
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8
Q

Describe the major functional role of the bladder

A
  • Body - temporary storage of urine
  • Neck - connects the bladder to the urethra
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9
Q

What are the 3 muscle components of the bladder

A
  • Detrusor urinae muscle
  • Internal urethral sphincter (physiological)
  • External urethral sphincter (anatomically formed by the pelvic floor muscles)
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10
Q

What are the 3 ways that the bladder receives neuronal innervation

A
  • Somatic division of the nervous system
  • Sympathetic division of the nervous system
  • Parasympathetic division of the nervous system
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11
Q

What are the layers of the body of the bladder (in to out)

A
  • Urothelium
  • Lamina Propria
  • Submucosa
  • Detrusor Muscle
  • Adventitia
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12
Q

What 2 layers of the body of the bladder make up the mucosa

A
  • Urothelium
  • Lamina propria
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13
Q

Name some characteristics of the detrusor muscle

A
  • Mass contracting muscle
  • Classed as a smooth muscle (but different from other smoot muscle as it does not have capacity for myogenic electrical activity)
  • No peristaltic activity
  • Lined with transitional epithelium (non secretory)
  • Same size in both sexes
  • Found in the lesser (or true) pelvic in adulthood but is in the abdomen in childhood
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14
Q

What innervates the external urethral sphincter and what does this mean

A
  • Innervated by the somatic nervous system
  • This means that it is under voluntary control
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15
Q

Where do all sympathetic innervation to the bladder originate from

A
  • Pre-ganglionic sympathetic fibres from spinal levels T12-L2 (make up the superior hypogastric plexus)
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16
Q

Where is the superior hypogastric plexus found

A
  • In the bifurcation of the aorta on the body of the fifth lumbar vertebrae and the sacrum
17
Q

Where do the fibres of the superior hypogastric plexus synapse and what do they become

A
  • They synapse within the inferior hypogastric plexus and contribute to the hypogastric nerve.
18
Q

Where is the inferior hypogastric plexus formed, and what are its functions

A
  • Lateral pelvic wall
  • Functionally mixed due to sympathetic and parasympathetic contributions
19
Q

What 3 systems of nerves form the inferior hypogastric plexus

A
  • Hypogastric nerves - from superior hypogastric plexus, sympathetic in function
  • Pelvic and splanchnic nerves - S2 to S4, parasympathetic in function
20
Q

Outline efferent innervation to the bladder

A
  • Sympathetic - T12 to L2 - through inferior hypogastric plexus - as hypogastric nerve
  • Parasympathetic - S2 to S4 - Through inferior hypogastric plexus - as pelvic and splanchnic nerves
21
Q

Outline afferent innervation to the bladder

A
  • Sensory nerves from bladder wall - S2 to S4
  • Bladder wall stretch - S2 to S4
22
Q

What are the effects of sympathetic supply on the bladder

A
  • Detrusor relaxation
  • Contraction of internal urethral sphincter
  • Narrowing of the opening of the urethra
23
Q

What are the effects of parasympathetic supply on the bladder

A
  • Detrusor muscle contraction
  • Relaxation of the internal urethral sphincter
24
Q

What are the effects of somatic supply on the bladder

A
  • Contraction of the external urethral sphincter during continence
  • Relaxation of the external urethral sphincter during micturition
25
Q

What are the necessary criteria for a stretch reflex equivalent to take place in the bladder (since its not a smooth muscle)

A
  • Bladder must have an intact sensation of filling or fullness
  • Parasympathetic efferents to the bladder must be intact and connected
  • There must be voluntary control of the external urethral sphincter by the individual
  • Sacral spinal cord must be intact
26
Q

Describe the steps of the stretch reflex of the urinary bladder

A
  • Filling of the bladder causes a stretch of bladder walls which is detected by the sensory afferents of the bladder - a sign of fullness.
  • Sensory afferents trigger parasympathetic efferents to increase detrusor activity via a reflex pathway.
  • Increase in detrusor activity leads to increase in intravesicular pressure and feeling of need to pass urine
27
Q

What is detrusor-sphincter dyssynergia

A
  • Detrusor muscle and external urethral sphincter contract simultaneously, bladder cannot void and you enter a state of urinary retention.
28
Q

What are Lower motoneuron signs (equivalence in autonomic dysfunction)

A
  • Flaccid paralysis - muscle weakness and loss of muscle tone
  • Hyporeflexia or Areflexia - reduced or completely diminished reflexes
  • Atonia - lack of muscle tone and tension
  • Known as autonomous bladder
29
Q

What causes the autonomous bladder

A
  • Bilateral damage of S2-S4 leading to loss of parasympathetic efferents and sensory afferents
30
Q

What are Upper motoneuron signs (equivalence in autonomic dysfunction)

A
  • Spastic paralysis - high level of muscle tone, stiffness and spasms
  • Hyperreflexia - exaggerated response to reflexes
  • Hypertonia - Increased muscle tone and stiffness
  • known as automatic reflexive bladder
31
Q

What causes an automatic reflexive bladder

A
  • Spinal cord damage above S2 to S4, loss of descending voluntary control of function.
  • Comparative to a baby’s bladder (automatic voiding every 1-4 hours)
32
Q

What is detrusor instability and what causes is

A
  • Involuntary and unexpected contraction of the detrusor muscle.
  • Caused by damage to spinal cord bilaterally around the lumbar region T12 to L2, no sympathetic drive to the bladder
  • Can be treated with botox
33
Q
A

Regional Anatomy - Sem 1 (11 decks)

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