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Kofi: Pure Clinical Sem 3 > Urinary: Bladder > Flashcards

Urinary: Bladder Flashcards

1
Q

How is the detrusor muscle controlled?

A

Purasympatheically through an M3 receptor

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2
Q

How is the sphincter muscle controlled?

A

Somatic innervation via the Pudendal nerve

S2, S3, S4

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3
Q

What is the features of the bladder phases?

A

Storage phase

  • Compliance
  • Sensation of bladder filling
  • No detrusor contraction

Voiding phase

  • Voluntary initiation
  • Complete emptying
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4
Q

What is the effect of a lower motor neurone lesion?

A
  • Low detrusor pressure
  • Large residual urine
  • Reduced perianal seasntion
  • Lax anal tone

+/- overflow incontinence

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5
Q

What is the effect of an upper motor neurone lesion?

A
  • High pressure detrusor contractions
  • Poor coordination with sphincters

Stops the inhibitor of the parasympathetic nerves

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6
Q

What are the types of incontinence?

A
  • Stress Urinary incontinence
  • Urge Urinary Incontinence
  • Mixed Urinary Incontinence
  • Overflow Incontinence
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7
Q

What are risk factors for incontinence?

A
  • Pregnancy and childbirth
  • Pelvic surgery
  • Pelvic prolapse
  • Race
  • Family predisposition
  • Anatomical abnormalities
  • Neurological abnormalities
  • Menopause
  • Drugs
  • UTI
  • Co-morbidities
  • Obesity
  • Age
  • Increase in intra-abdominal pressure
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8
Q

How is uriniary incontinence examined?

A

History to categorise type of UI

Examination

  • BMI
  • Abdominal exam
  • Digital Rectal examination (prostate, limited neurological examination)
  • Females (external genitalia stress test, vaginal exam)
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9
Q

What are investigations undertaken for urinary incontinence?

A
  • Urine dipstick mandatory
  • Basic non-ivasic urodynamics (frequency-volume chart, bladder diary, post micturition residual volume)

Optional
Invasive urodynamic
Pad tests
Cystoscopy

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10
Q

What are the conservative management options for Urinary Incontinence?

A
  • Modify fluid intake
  • Weight loss
  • Stop smoking
  • Decrease caffeine intake
  • Avoid constipation
  • Timed voiding - fixed schedule
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11
Q

What is contained incontinence?

A
  • Indwelling catheter
  • Sheath device
  • Incontinence pads

For patient suitable for surgery who have failed conservative or medical management

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12
Q

What are the management options for stress urinary incontinence?

A

Initial management
-Pelvic floor muscle training

Pharmacological Management
-Duloxetine for combined noradrenaline and serotonin uptake inhibitor and increased activity in striated sphincter during filling phase

Surgery. Permanent (P) and Temporary (T)

Females

  • Low tension vaginal tapes (P)
  • Open retropubic suspension procedures (P)
  • Classic sling procedures (P)
  • Intramural bulking agents (T)

Males

  • Artificial urinary sphincter
  • Male sling procedure
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13
Q

What are the specific management of Urge Urinary Incontinence?

A

Initial management
-Bladder training (schedule of voiding for at least 6 weeks)

Pharmacological management

  • Anticholinergics (oxybutynin) which acts on muscurrinic receptors (M2,M3). Has side effects on other sites.
  • B3 adrenoreceptor agonist (Mirabegron) to increase bladder’s capacity to store urine
  • Intravesical injection of Botulinum toxin to inhibit release fo Act at pre-synaptic neuromuscular junction causing flaccid paralysis

Surgery

  • Sacral nerve neuromodulation
  • Autoaugmentaion
  • Augmentation cystoplasty
  • Urinary diversion
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14
Q

Which area can stones lodge to cause hydronephrosis?

A

-Pelvo-Ureteric junction can be an area in which stone can lodge causing Hydronephrosis. This can lead to AKI.

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15
Q

What can stasis of Urine lead to?

A

Can lead to pyelonephritis due to stasis of the urine leading to infection

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16
Q

What are the borders of the trigone?

A
  • Both Internal ureteric entrance
  • External urethral meatus.
  • Imaginary line connecting these forms the Trigone
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17
Q

What is the most strongly tethered portion of the bladder?

A

Trigone is the most strongly tethered portion of the bladder.

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18
Q

Where is the trigone derived?

A

Trigone derived from the Wolffian ducts whilst remainder is from endoderm derived urogenital sinus

19
Q

Why is the back of the bladder tethered down?

A

Back of the bladder is tethered down due different different embryological origin

20
Q

Which spaces are filled when a patient lays down?

A

The rectovesicular pouch and uterovesicular pouch is where fluid collects

21
Q

What are structures found within the bladder?

A

-Bladder wall has rugae. Then detrusor muscle as well

22
Q

What cancers can present in the bladder?

A
  • Bladder normally has a transitional cell carcinoma
  • At the tip of the bladder if there is a cancer, it can be an adenocarcinoma due to a different embryological origin of the Urachus
23
Q

What is the course of the urethra?

A
  • Penile Urethra
  • Spongy urethra
  • Bulbuous urethra
  • Membranous urethra (urogenital diaphragm)
  • Prostatic urethra
24
Q

Why can inacrurances occur in urine dipstick?

A
  • Extreme exercise can cause proteinuria and haematuria
  • Menstruation
  • Indwelling catheters (always have an infection
25
Q

What are general examination for acute kidney infection?

A
  • General appearance (Pallor, Uraemia, Nails, Rashes, Bruises)
  • CVS/RS (BP, Fluid balance – (JVP, RR, O2 saturation, Chest sounds), Heart sounds – (Additional sounds, murmurs), Bruits)
  • GIS/GUS (Palpable masses including bladder, Pain, Ballotable kidneys, Abdominal bruits, Urine outputs)
26
Q

What are the features of urine microscopy?

A
  • Infection – send for culture
  • Crystals (Look under microscope, Gout, Pseudogout)
  • Casts
  • Red cell casts
27
Q

What are the predisposing factors to UTI?

A
  • Shorter urethra
  • Obstruction
  • Neurological problems
  • Ureteric reflux
28
Q

Which organism is commonly associated with UTI?

A

E-Coli

29
Q

What are the virulence factors of E.coli that allow it to evade the immune defence?

A
  • Fimbriae allow attachment to host epithelium
  • Haemolysins damage host membranes and cause renal damage
  • K antigen permits production of polysaccharide capsule
  • Urease breaks down urea creating a favourable environment for bacterial growth
30
Q

What are common syndromes presented as a result of UTI?

A
  • Cystitis –frequency and dysuria (lower UTI)
  • Acute pyelonephritis (upper UTI)
  • Chronic pyelonephritis
  • Asymptomatic bacteriuria (e.g. pregnancy)
  • Septicaemia +/- shock
31
Q

What are the clinical symptoms of lower UTI?

A
  • Dysuria
  • Frequency
  • Urgency
  • Low grade fever sometimes
32
Q

What are the clinical symptoms of upper UTI?

A
  • Fever
  • Loin Pain
  • May have dysuria and frequency
33
Q

What is an uncomplicated UTI?

A

Defined as infection by a usual organism in a patient with a normal urinary tract and normal urinary function.

34
Q

What is a complicated UTI?

A

UTI when one or more factors are present that predispose the person to persistent infection, recurrent infection, or treatment failure.

35
Q

What are examples of predisposing factors to complicated UTI?

A
  • Abnormal urinary tract (e.g., vesico-ureteric reflux, indwelling catheter, etc).
  • Virulent organism (e.g.Staph. aureus).
  • Impaired host defences (e.g. poorly controlled diabetes, immunosuppression).
  • Impaired renal function
36
Q

What are most cases of UTI in children, men and pregnant women treated as?

A

Complicated UTI

37
Q

What is the investigation undertaken in UTI?

A
  • In healthy non-pregnancy women of child-bearing age, no need to culture urine
  • Culture urine in complicated UTI
38
Q

How are patient screened for UTI?

A
  • Turbidity

- Dipstick testing (useful to exclude UTI)

39
Q

When is a dipstick testing not useful for in diagnosis of UTI?

A
  • Acute uncomplicated UTI in women
  • Men with typical/severe symptoms
  • Catheterised patients
  • Older patient without features of infection
40
Q

What is the treatment for uncomplicated UTI?

A
  • Increase fluid intake
  • Address underlying disorders
  • 3 days course of Trimethoprim or nitrofurantoin
  • Check with cultures post treatment in children and pregnant women
41
Q

What is the treatment for simple cystitis?

A
  • Uncomplicated infections can be treated with trimethoprim or nitrofurantoin
  • 3 days course
42
Q

How are complicated lower UTI’s treated?

A
  • Trimethoprim (7 day)
  • Nitrofurantoin – specific to bladder
  • Cephalexin
43
Q

What is the treatment for pyelonephritis/septicaemia?

A
  • Co-amoxiclav
  • Ciprofloxacin (7 days also effective)
  • Gentamicin IV
44
Q

How is UTI prophylactically prevented?

A

Trimethoprim or nitrofurantoin

  • Single nightly dose
  • Ensure all breakthrough infections documented
  • Three or more episodes a year but not treatable underlying conditons

Kofi: Pure Clinical Sem 3 (44 decks)

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