Urinary Bladder, Microturition and Infections

Question 1

what is the function of the bladder?

Answer 1

a temporary storage of urine that can empty at an appropriate time

Question 2

where is the bladder situated when empty?

Answer 2

in the pelvic cavity

Question 3

where is the bladder situated when full?

Answer 3

partly in the pelvic cavity but expands superiorly into the abdominal cavity

Question 4

at what age does the bladder descend into the pelvis area from the abdominal area?

Answer 4

by the 5th or 6th age

Question 5

what are the 4 parts of the urinary bladder?

Answer 5

1. apex
2. base
3. superior surface
4. inferolateral surface

Question 6

what is the mucosal lining of the base of the bladder like?

Answer 6

smooth firmly attached to the wall

Question 7

what is the mucosal lining of the base of the bladder attached to?

Answer 7

the underlying smooth muscle coat of the wall

Question 8

what is the mucosal lining of the bladder like elsewhere besides the base?

Answer 8

folded and loosely attached to the wall

Question 9

what is the trigone?

Answer 9

he smooth triangular area between the openings of the ureters and urethra on the inside of the bladder

Question 10

what is the main difference between a male and female’s bladder and urethra?

Answer 10

males have an internal and external urethral sphincter but females only have an external one.

Question 11

what does the sympathetic nerve do to the bladder?

Answer 11

transmit impulses from the pain receptors to the upper lumbar segment resulting in the perception of pain sensation from the urethra & bladder.

Question 12

what does the pelvic (parasympathetic) nerve do to the bladder?

Answer 12

transmit impulses from the tension and pain receptors present in the wall of the bladder to the sacral region of spinal cord resulting in both reflex micturition & sensation of bladder fullness

Question 13

what does the pudendal (somatic) nerve do to the bladder?

Answer 13

transmit impulses for the sensation of:
 Distention of the urethra.
 Passage of urine through
the urethra.
 Maintains the tonic contractions of the skeletal muscle fibers of the external sphincter.

Question 14

how does the pelvic nerve work?

Answer 14

releases ACh at the M3 receptor on the bladder to cause muscle contraction to force the urine out

Question 15

how does the sympathetic nerve work?

Answer 15

releases noradrenaline at the bladder beta receptor and urethra alpha receptor to:
1. inhibit contraction of the bladder
2. stimulate contraction of the urethra.
Both to prevent urine release

Question 16

How does the pudendal (somatic) nerve work?

Answer 16

releases ACh at the nicotinic receptors of the external urethral sphincter to cause contraction hence preventing urine release

Question 17

what fibres supply the sympathetic system in the bladder?

Answer 17

The preganglionic fibres which branch from the upper 4 lumbar vertebrate.
The postganglionic fibres arise from the hypogastric ganglia

Question 18

what are the functions of the sympathetic nerves?

Answer 18

 Inhibitory to the bladder wall (detrusor muscle).
 Motor to the internal urethral sphincter.
 Motor to the seminal vesicle, ejaculatory duct & prostatic musculature. It prevents the reflux of semen into the bladder.

Question 19

what is the wall of the bladder called?

Answer 19

the detrusor wall

Question 20

what fibres supply the parasympathetic system in the bladder?

Answer 20

the preganglionic fibres from the 2nd, 3rd and 4th sacral segments the vertebrate

Question 21

what are the functions of the parasympathetic nerves?

Answer 21

 Motor to the bladder wall (detrusor muscle).

 Inhibitory to the internal urethral sphincter.

Question 22

what fibres supply the somatic system in the bladder?

Answer 22

-they arise from the 2nd, 3rd and 4th sacral segments and supplies the external urethral sphincter

Question 23

what is the function of the somatic supply?

Answer 23

 Motor to the external uretheral sphincter.

Question 24

when does the micturition reflex start to appear??

Answer 24

from stage 1 when the bladder reaches 150-300ml. So the early stage of feeling the urge to urinate

Question 25

at what point can micturition no longer be suppressed?

Answer 25

at about 700ml (break point)

Question 26

what is the storage phase of micturition?

Answer 26

the filling phase

Question 27

what is the voiding phase of micturition?

Answer 27

the emptying phase

Question 28

what helps to empty the female urethra?

Answer 28

gravity

Question 29

how is urine in the urethra of the male expelled?

Answer 29

by several contractions of the bulbocavernosus muscle.

Question 30

what part of the brain receives and coordinates the detrusor afferent stimuli?

Answer 30

The parietal lobes and thalamus

Question 31

what part of the brain provides modulation with inhibitory signals?

Answer 31

the frontal lobes and basal ganglia

Question 32

where does central coordination occur?

Answer 32

in the pontine micturition centre

Question 33

The cortical centres facilitate micturition by discharging signals which leads to what?

Answer 33

 Stimulation of sacral micturition center.  Inhibition of pudendal nerves which causes relaxation of external urethral sphincter.  Contraction of anterior abdominal muscle & diaphragm to increase intra-abdominal pressure. This intensifies the micturition reflex.  Voiding under parasympathetic regulation (pelvic nerve)

Question 34

The higher centres inhibit micturition by what?

Answer 34

 Inhibition of sacral micturition center.  Stimulation of pudendal nerves ⇒ contraction of external urethral sphincter.  Holding of urine under sympathetic regulation (hypogastric nerve)

Question 35

what is a cystometrogram?

Answer 35

a graph of the pressure applied on the bladder against the volume of urine in the bladder

Question 36

What are the 3 types of incontinence?

Answer 36

1. overflow 2. stress 3. urge

Question 37

what is overflow?

Answer 37

blockage of the urethra so the bladder can't empty properly

Question 38

what is stress?

Answer 38

when the pelvic floor is relaxed causing increased abdominal pressure

Question 39

what is urge?

Answer 39

when the bladder is oversensitive due to an infection that causes neurological disorders.

Question 40

what is atonic (hypotonic) bladder?

Answer 40

- when the sensory nerve fibers from the bladder are destroyed e.g. by a disease, injury - causes the person to loose bladder control as the bladder muscle looses the tone and becomes flaccid so urine overflows and drips through the urethra.

Question 41

how to treat atonic bladder?

Answer 41

* Bladder catheterization and correction of the underlying causes * Neurogenic problems treated with anticholinesterases to increase detrusor contraction.

Question 42

what type of drugs make atonic bladder worse?

Answer 42

antimuscarinics

Question 43

what is Spastic neurogenic (automatic) bladder?

Answer 43

- During spinal shock after complete transection of spinal cord above sacral centres of micturition, the urinary bladder looses its tone and becomes flaccid and unresponsive causing overflow. - spinal shock due to sudden separation of the spinal centres from the higher centres that control them - when bladder is filled with some amount of urine, there is automatic evacuation of the bladder

Question 44

what is uninhibited neurogenic bladder?

Answer 44

- a lesion in some parts of the brain stem interprets inhibitory signals so we get continuous excitation of spinal micturition centres by the higher centres. - micturition is now uncontrolled increasing need to urinate

Question 45

what is Nocturnal micturition?

Answer 45

AKA bed wetting: - common in infants and kind <3yrs old - occurs due to incomplete myelination of motor nerve fibers of the bladder resulting loss of voluntary control of micturition

Question 46

what is Overactive bladder syndrome?

Answer 46

when the detrusor produces uncontrolled bladder contractions during normal filling. - can be associated with a stroke, spinal injury, MS - can also be secondary to the meds already taking - causes urinary urgency and frequency, nocturia

Question 47

what is urethral sphincter incompetence?

Answer 47

- Dribbling and/or continuous leakage associated with incomplete bladder emptying, due to impaired detrusor contractility and/or bladder outlet obstruction. - Urethral sphincter incompetence produces stress incontinence in women (urine leakage with effort, exertion, coughing etc.) or sphincter weakness incontinence in men.

Question 48

what is Painful bladder syndrome/interstitial cystitis (PBS/IC)?

Answer 48

- urothelial abnormalities alter bladder epithelial expression of HLA Class I and II antigens - so the bladder sensory neurones are activated during normal bladder filling