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Renal > Urinary Continence and Renal Pain > Flashcards

Urinary Continence and Renal Pain Flashcards

1
Q

What nerve fibres give sensory innervation?

A

Somatic sensory = sensations from body wall

Visceral afferent = sensations from organs

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2
Q

What nerve fibres give motor innervation?

A

Somatic motor = motor responses to body wall and stimulate skeletal muscle to contract
Parasympathetic/sympathetic = stimulate smooth and cardiac muscle and glands

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3
Q

What nerves modalities control ureteric peristalsis and bladder contraction?

A

Sympathetic and parasympathetic

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4
Q

What nerve modalities are responsible for urethral sphincter control?

A

Sympathetic and parasympathetic = internal sphincter

Somatic motor = external sphincter, levator ani

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5
Q

What nerve modality is responsible for the perception of pain from the kidneys, ureters and bladder respectively?

A

Visceral afferent nerve fibres

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6
Q

What nerve modality is responsible for pain from the urethra?

A

Visceral afferent in pelvis

Somatic sensory in perineum

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7
Q

What nerve modality is responsible for pain from the testes?

A

Visceral afferents with some somatic presentation also

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8
Q

What modalities are involved in the voluntary control of urinary elimination?

A

Sympathetic, parasympathetic, somatic motor, visceral afferent

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9
Q

Where do the lumbar and sacral plexuses supply?

A

Perineum and lower limbs = supply both somatic motor and sensory

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10
Q

How many pairs of spinal nerves are there?

A

31 pairs in total = 12 pair of cranial nerves

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11
Q

What is the only way any type of nerve fibre can communicate with the CNS?

A

By being carried within the cranial or spinal nerves

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12
Q

Where do sympathetic fibres leave the CNS?

A

Within spinal nerves between T1-L2 (thoracolumbar outflow) = join somatic motor and sensory fibres

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13
Q

How do sympathetic fibres reach the smooth muscle and glands of the body wall?

A

Within spinal nerves

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14
Q

How do sympathetic fibres reach the smooth muscle and glands in the body?

A

Within the splanchnic nerves = cardiopulmonary or abdominopelvic

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15
Q

How do sympathetic fibres reach the head?

A

Follow the arteries which supply the same structure

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16
Q

What level do sympathetic fibres leave the cord at to supply the urinary system?

A

Between T10-L2 levels = enter sympathetic chain bilaterally but don’t synapse

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17
Q

What do sympathetic fibres leave the sympathetic chain with when travelling to supply the urinary system?

A

Abdominopelvic splanchnic nerves

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18
Q

Where do sympathetic fibres synapse when travelling to the urinary system?

A

Synapse at the abdominal sympathetic ganglia = located around the abdominal aorta

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19
Q

Where do post-synaptic sympathetic fibres pass to once they leave the abdominal sympathetic ganglia?

A

Pass onto the surface of the arteries which head towards the organs

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20
Q

What is a peri-arterial plexus?

A

Collection of nerve fibres found on the outside of arteries = also contain parasympathetic and visceral afferent fibres

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21
Q

How do parasympathetic fibres leave the CNS?

A

Within four cranial nerves = CN III, VII, IX and X

Within the sacral spinal nerves

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22
Q

Do parasympathetic fibres supply the smooth muscle and glands of the body wall?

A

No = supply smooth muscle and glands of head and body

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23
Q

How do parasympathetic fibres reach the hindgut and pelvic organs?

A

Via pelvic splanchnic nerves = also carried briefly within sacral spinal nerves

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24
Q

What cranial nerve carries parasympathetic fibres to the kidneys and ureters?

A

Vagus nerve (CN X)

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25
Q

What nerves innervate the bladder?

A

Pelvic splanchnic nerves = S2-4

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26
Q

Where do somatic motor fibres supply?

A

Only structures of the body wall

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27
Q

What parts of the renal system receive somatic motor fibres?

A

Only parts within the perineum = urethra distal to the pelvic floor, external urethral sphincter, levator ani

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28
Q

What are some nerves that carry somatic motor fibres to the urinary system?

A

S2-4, pudendal nerve

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29
Q

Where is pain from the kidney felt?

A

Dull, achy pain felt in loin = posterior aspect of flank on affected side, usually felt in dermatomes

30
Q

Where is pain from the bladder felt|?

A

Midline in the suprapubic region = dull, achy pain

31
Q

Where is pain from the perineal part of the urethra felt?

A

Quite localised in the perineum

32
Q

Where is pain caused by a calculus obstructing the ureter felt?

A

Radiates from loin to groin on affected side

33
Q

Where is pain from the distal urethra felt?

A

Localised within perineum = sharp pain

34
Q

Where is pain from the testes felt?

A

Often felt in scrotum but can radiate to groin and anterior lower abdomen

35
Q

Where do visceral afferent fibres from the kidney travel?

A

Run alongside sympathetic fibres back to spinal cord = enter spinal cord between T11 and L1

36
Q

What are some differentials for loin pain?

A

Skin origin (e.g shingles), muscular pain, vertebrae pain, spinal nerve root compression, lower lobe pneumonia

37
Q

Where do visceral afferent fibres from the ureters enter the spinal cord?

A

Between T11 and L2 level = pain may be felt anywhere along their path

38
Q

What are some differentials of groin pain?

A

Hernias (inguinal, femoral), lymphadenopathy, testicular pathology

39
Q

What part of the bladder do visceral afferent fibres carry pain from?

A

The part that touches the peritoneum = return to spinal cord at T11-L2 level

40
Q

Where do visceral afferent fibres from parts of the bladder not touching the peritoneum enter the spinal cord?

A

Run alongside parasympathetic fibres back to spinal cord between S2-4

41
Q

What are some differentials of supra-pubic pain?

A

Hindgut organ pain, other single midline pelvic organs whose superior aspect touches the peritoneum

42
Q

What part of the urethra do visceral afferent fibres innervate?

A

Proximal urethra (above levator ani and in pelvis) = run alongside parasympathetic fibres back to spinal cord at S2-4 level

43
Q

Where do somatic sensory fibres that supply the areas of the urethra not innervated by visceral afferent fibres enter the spinal cord?

A

Carried within pudendal nerve to S2-4 level = pain localised in perineum

44
Q

What are some differentials of perineal pain?

A

Vaginal tear, anal canal fissure, perineal genital ulcers

45
Q

Why do visceral afferent fibres from the testes run alongside the sympathetic fibres?

A

Due to their embryological descent = enter spinal cord at T10-11

46
Q

Why can pain from the testes sometimes be felt in the L1 region?

A

Due to their close relationship with the scrotal wall = pain may be localised to scrotum or groin

47
Q

What are the differentials of scrotal pain?

A

Skin lesions, strangulated inguinal hernia

48
Q

What level of the spinal cord is essential in controlling urine flow?

A

S2-4

49
Q

What modalities are present at S2-4 level?

A

Visceral afferents entering
Pelvic splanchnic nerves (parasympathetic) leaving
Pudendal nerves formed at this level = carry somatic sensory and motor nerve fibres

50
Q

What happens when the bladder fills?

A

Sensed by stretch receptors at end of visceral afferent fibres = relayed to CNS at S2-4 levels

51
Q

What bladder reflex only occurs in males?

A

Reflex to empty bladder by stimulation of detrusor muscle and inhibition of internal sphincter muscle

52
Q

Why are adults and potty trained children able to over-ride reflexive bladder voiding?

A

Have action potentials within inhibitory nerve fibres from the cortex which pass inferiorly

53
Q

What are adults able to do in regards to the bladder that infants cannot?

A

Voluntarily contract external sphincter and levator ani muscles

54
Q

What happens when an adult decides to void their bladder?

A 
Detrusor contracts (parasympathetic)
Internal urethral sphincter (parasympathetic), external urethral sphincter and levator ani relax (somatic motor)
55
Q

Why do the anterolateral abdominal wall muscles contract during bladder voiding?

A

Increases intra-abdominal pressure and forces urine out of the external urethral orifice = under somatic motor control

56
Q

What forms nerve plexuses?

A

Anterior rami of spinal nerves

57
Q

What nerves does the sacral plexus give rise to?

A

Pudendal nerve = S2-4

Sciatic nerve = L4-S3

58
Q

What are some nerves given off by the lumbar plexus?

A

Iliohypogastric and ilioinguinal nerves = L1 level
Lateral cutaneous nerve of the thigh = L2-3 levels
Femoral and obturator nerves = L2-4 levels
Genitofemoral nerve = L1-2 levels

59
Q

What structure is the femoral nerve located under?

A

The inguinal ligament = supplies anterior compartment of thigh, becomes saphenous nerve

60
Q

What structure does the obturator nerve pass through to supply the medial compartment of the thigh?

A

Obturator foramen

61
Q

How does the sciatic nerve reach the posterior compartment of the thigh?

A

Goes via the gluteal region = splits into tibial nerve and common fibular nerve

62
Q

Where does the tibial nerve supply?

A

Posterior compartment of leg and intrinsic muscles of foot

63
Q

Where does the common fibular nerve supply?

A

Deep branch = anterior compartment of leg

Superficial branch = lateral compartment of leg

64
Q

What nerves form the sural nerve?

A

Tibial and common fibular nerves = supplies sensation to lateral aspect of foot

65
Q

What supplies the first web space of the foot?

A

Deep fibular nerve

66
Q

What supplies sensation to the plantar aspect of the foot?

A

Tibial nerve

67
Q

What controls ureteric peristalsis?

A

Automatic action initiated and propagated by ureteric cells which have their own auto-rhythmicity

68
Q

What controls bladder contraction?

A

Parasympathetic fibres from S2-4 via pelvic splanchnic nerves stimulate detrusor muscle to contract

69
Q

What causes the internal urethral sphincter to contract in males?

A

Stimulation by sympathetic fibres = occurs during ejaculation

70
Q

What causes the internal urethral sphincter to relax?

A

Stimulation by parasympathetic fibres = allows urine to flow through urethra

71
Q

What causes the external urethral sphincter to contract?

A

Somatic motor fibres within the pudendal nerve (S2-4)

72
Q

What causes the levator ani to contract?

A

Somatic motor fibres within the nerve to levator ani (S3-4)

Renal (36 decks)

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