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surgery > Urinary Bladder Disorder ---ماجد اضغر > Flashcards

Urinary Bladder Disorder ---ماجد اضغر Flashcards

1
Q

whats the location of the bladder when its full or empty ?

A
  • when its empty its lies behind the pubic symphesis

- when the bladder is full it lie above the symphesis so can be palpated and precussed

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2
Q

how the ureter enter the bladder and how much the distance between both ureters ?

A

ureter enter posterioinferiorly in oblique maner

they re 5cm apart

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3
Q

what the location of the bladder in the male and female ?

A
  • in male it lie posteriorly to seminal vesicle ,vasa deferentia ,ureter and rectum
  • in female the the uterus and vagina is located between the bladder and the rectum
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4
Q

what happen if there is truma in the lower abdominal wall and the bladder is full ?

A

in both sexes when the bladder distended it will be in contact with the lower abdominal wall and cause truma as weel

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5
Q

what the type of the mucosa of the bladder ?

A

is transitional

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6
Q

what the muscle of the bladder ?

A

bundles are run longitudinally and circulary

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7
Q

whats the blood supply of the bladder ?

A
  • sup, med , inf vesical artery is branch from the internal illic trunk
  • also from obterator artery and inferior gluteal artery
  • in female uterine and vaginal branches

while the venous into the internal illiac artery

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8
Q

where the lymphatic drainage of the bladder ?

A

vesical ,external , internal illiac and common iliac LN

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9
Q

what’re the congenital anomalies of the bladder ?

A

1- extrophy of the bladder

2- persistant urachus

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10
Q

whats the dystrophy of the bladder ?

A
  • its ventral defect in the bladder where the inner surface of the post wall of the bladder appear exposed in the abdomen with defect in the skeletal muscle
  • also the pubic bone is widely seperated
  • epispadias (urethra ends in an opening on the upper aspect of the penis ,in females when the urethra develops too far anteriorly.)
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11
Q

whatre the complication of the extrophy of the bladder ?

A
  • renal infection is very common and hydronephrosis (kidney swells ) because of bstruction is uretrovesical junction
  • have carcinoma (adenocarcioma)
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12
Q

how to repair the extrophy of the bladder ?

A

by surgery done at 3 -18 month

-1st we do complete reconstruction (نعيده للوضع السابق ) to
the defect and close the bladder

  • to fixed the seperation in the pubic bone we need to do sacral osteotomy
  • bladder neck reconstruction and antiureteral reflex procedure
  • also repair the epispadic penis
  • if the bladder with small capacity need to do augmentation(زياده ) cyctoplasty

نعدل المثانه والعضم و اليورثرا

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13
Q

whats the persistant urachus ?

A

(At birth the urachus attach the bladder to the umbilicus)

so if there is incomplete obliteration the urachus either open in umblicus or bladder or connect for both in this condition the urine drain by umblicus

-if the sup end still opened it cause umblical sinus
if the inf end remain opened cause comincation with bladder

  • is both sup and inf end remain opened cause urine drainage from the umblicus
  • if only the end obliterate it form urachal cyct
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14
Q

what happen if the sup end still opened ?

A

cause umblical sinus

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15
Q

what happen if the inf end remain opened ?

A

cause comincation with bladder

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16
Q

what happen if both sup and inf end remain opened ?

A

cause urine drainage from the umblicus

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17
Q

what happen if only the end obliterate ?

A

it form urachal cyct

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18
Q

what the treatment of the persistant urachus ?

A

excision of the urachus

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19
Q

what the internal vesical herniation ?

A

its aquired disease
when one side of bladder involve in
-the inguinal hernia in male
- femoral hernia in female

20
Q

what the treatment of the internal vesical herniation ?

A

laproscopic surgery with mesh

21
Q

whats the Enuresis?

A

bedwetting at age of 3 years in the 6 years happen about 10%

22
Q

whats the cause Enuresis?

A
  • Gentic factor is primary cause of the enuresis
  • 50% of them will have delay maturation in the maturation or interinsic myoneurogenic bladder dysfunction
  • 30% is psychatric
  • 20 % seconday to the other orgainc disease
23
Q

whats the clinical features of the Enuresis?

A
  • bed wet regurally
  • normal examination physical and urological
  • no burning and all the lab investigation and imaging study is normal
  • but the cyctometric studies show hyperirritable neuropathic bladder
24
Q

whats the differential diagnosis of Enuresis?

A

1- lower urinary tract obstrction
stricture or stenosis os some problem in the valve

2-or choronic urinary infection
3- neurogenic bladder

25
Q

whats the treatment of Enuresis?

A

general measures

  • limit fluid intake
  • empty bladder at bedtime and child should be awakened

1- impramine
start with dose is 25mg befor dinner then 50mg

2- parasympathtic
3- sympathomimetic
4 desmopressin (anti diuretic)

26
Q

whats the acute cyctitis ?

A

inflamed bladder affcted highly sexul female because of short urethra
-mot common cause is the accending infection
-may be heamtogenous
but the primary rout is the fecal -perinal -urethral rout

80 % Ecoli

27
Q

whats the clincal feature of acute cyctitis ?

A
  • frequency , dysuria, urgency
  • pain in lower back and suprapubic
  • no systemic menfestation
28
Q

how to dignosis acute cyctitis ?

A

urinlysis , urine culture , urine dipstick

29
Q

whats the treatment of acute cyctitis ?

A

Trimethoprim/sulfamethoxazole. TMP-SMX
nitrofurantoin
flouroquinolone
3-5 day treatment

30
Q

whats the recurrent cyctitis ?

A

its infection either it
persistant (with)
or reinfection with (other organism)

31
Q

whats the investigation for recurrent cyctitis ?

A 
1- U/S 
2- IVP (intraveous polygram radiological procedure used to visualize abnormalities of the urinary system, including the kidneys, ureters, and bladder.)
3-CT 
4- cystoscpoy 
to see if there is stone
32
Q

whats the treatment for recurrent cyctitis ?

A

surgical to remove the stone
-in most cases of the reinfection give prophylactic antibiotic then low dose continious antibiotiic

  • or use alternative to the antibiotic as lactobacillus vaginal suppositeries and canberry juice التوت البري
33
Q

what the vesical diverticula ?

A

when increase in the pressure intravesicaly the mocosa will herniate
most common its secondary to obstruction so it will located distal to the bladder neck
but may be because of neurogenic bladder (upper motor neuron)

34
Q

what the complication of vesical diverticula ?

A

1- residual urine may develop
2- may be there is reflex. when the diverticula located sup
3-infection
4- carcinoma

35
Q

what the treatment of vesical diverticula ?

A

resection of the diverticulum

36
Q

Dose the vesical fistula common ?

A

yes its common , may comunicate to the skin , intestine , or in female to the reproductive tract

37
Q

what the cause of vesical fistula?

A

1- primary intestinal disease
2- primary gyncolgical disease
3- after treatment of the gynological disease
4- trauma

38
Q

what the primary intestinal disease that can cause fistula ?

A

diverticulosis 60-50%
colon cancer 20-25%
crohn disease 10%

39
Q

what the primary gyncolgical disease that can cause fistula ?

A
  • beacuse of the labor which cause pressure necrosis

- carcinoma in the cervix

40
Q

what the treatment of the gynological disease hat can cause fistula ?

A

hysterectomy (surgical removal of the uterus)
low CS
radiotherapy

41
Q

whats the clinical feature of the vesicointestinal fistula ?

A
  • feces and gases pass throght the urine
  • urine is infected
  • change in the bowel habbit
42
Q

whats the investigation for vesicointestinal fistula ?

A
  • barium enema
  • sigmodoscopy
  • cyctogram
  • cyctoscopy
43
Q

whats the treatment for vesicointestinal fistula ?

A

proximal colostomy and repair

44
Q

whats the clinical feature of the vesiecovaginal fistula ?

A

very common

-urine leak from vagina

45
Q

whats the investigation for vesicovaginal fistula ?

A

cyctoscopy and vagioscopy

46
Q

whats the treatment for vesicovaginal fistula ?

A

surgical repair

surgery (28 decks)

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