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2 RENAL > Urinary Continence and Renal System Pain > Flashcards

Urinary Continence and Renal System Pain Flashcards

1
Q

what are the motor functions of the renal system

A

Ureteric peristalsis
Bladder contraction
Urethral sphincter control (internal and external urethral sphincters)

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2
Q

where is pain sensed in the renal system

A 
kidney pain 
ureter pain 
bladder pain 
urethra pain 
pain from testes - not technically renal
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3
Q

what is urinary continence

A

the voluntary control of the elimination of urine from the bladder

this is a motor and sensory function

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4
Q

where does the lumbar and sacral plexus give innervation to (motor and sensory)

A

perineum (distal part of renal system)

lower limbs

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5
Q

what nerve fibres convey sensations from the body wall to the CNS

A

somatic sensory

soma meaning wall

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6
Q

what nerve fibres convey sensations from the viscera (organs) to the CNS

A

visceral afferent nerve fibres

afferent - towards brain

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7
Q

what nerve fibres stimulate movement in the body wall from the CNS

A

somatic motor

stimulate skeletal muscle voluntarily to contract

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8
Q

what nerve fibres stimulate movement in internal organs from the CNS

A

parasympathetic nerve fibres OR sympathetic move fibres

sympathetic stimulate smooth muscle, cardiac muscle or glands

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9
Q

what nerve fibres control ureteric peristalsis

A

sympathetic/parasympathetic

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10
Q

what nerve fibres control bladder contraction

A

sympathetic/parasympathetic

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11
Q

what nerve fibres control internal and external urethral sphincter control

A

sympathetic/parasympathetic (internal sphincter in males)

somatic motor (external sphincter and levaor ani)

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12
Q

what nerves sense pain in the urethra

A

visceral afferent in the pelvis

somatic sensory in the perineum

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13
Q

how do nerves communicated with CNS

A

via either cranial nerves or spinal nerves

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14
Q

what types of nerves are carried the entire length of spinal/cranial nerves

A

somatic motor

somatic sensory

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15
Q

how do sympathetic and parasympathetic nerves and visceral afferents make use of the cranial/spinal nerves

A

travel along them for limited portions to get in and out of CNS

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16
Q

where do sympathetic nerve fibres leave the spinal cord

A

only within the spinal nerves between spinal cord levels
T1-L2

(thoracolumbar)

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17
Q

how do sympathetic fibres reach the smooth muscle/glands of the body wall

A

from within the spinal nerves

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18
Q

how do sympathetic fibres reach the smooth muscle/glands of the body (other than the wall)

A

through splanchnic nerves (cardiopulmonary or abdominopelvic)

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19
Q

how do sympathetic fibres reach the smooth muscle/glands of the head

A

by ‘hitching a ride’ with arteries supplying the same structure

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20
Q

what do sympathetic fibres do

A

supply motor innervation to smooth muscle, cardiac muscle and glands in the body

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21
Q

what fibres do the spinal nerves carry

A

somatic motor
somatic sensory
sympathetic fibres

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22
Q

how many spinal nerves are there

A

31 pairs

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23
Q

how many cranial nerves are there

A

12 pairs

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24
Q

where does the sympathetic chain run

A

entire length of the vertebral column

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25
Q

how do sympathetic nerve fibres get from the CNS to the kidneys, ureters and bladder

A

leave spinal cord at T10 and L2

enter sympathetic chain

leave sympathetic chain with abdominopelvic splanchnic nerves

synapse at the abdominal sympathetic ganglia which are located around the abdominal aorta

then pass from ganglia to the surface or arteries which are heading to the organs they innervate

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26
Q

what is the collection of nerve fibres found on the outside of arteries called

A

periarterial plexus

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27
Q

what nerve fibres (other than sympathetic) are in periarterial plexuses

A

parasympathetic
visceral afferent

(bc they all go to/come back from the same organ)

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28
Q

how do parasympathetic nerve fibres reach the hindgut and pelvic organs

A

pelvic splanchnic nerves

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29
Q

how do parasympathetic fibres reach the smooth muscle/glands of the head

A

via cranial nerves

III, VII, IX and X

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30
Q

how do parasympathetic nerve fibres get from the CNS to the kidneys, ureters and bladder

A

carried within the VAGUS nerve to kidneys and ureter

carried with pelvic splanchnic nerves to bladder

31
Q

what part of the renal system do somatic motor nerves go to

A

the perineum

(eg, urethral distal to pelvic floor and its sphincter) as there’s are part of the body wall

32
Q

where can pain from a calculus in the ureter be filled

A

‘loin to groin’ on addicted side

33
Q

where can pain from the kidney itself be felt (eg. in acute hydronephrosis)

A

the loin

posterior aspect of the flank region on the affected side

34
Q

where is pain from the bladder felt

A

in the suprapubic region (midline)

35
Q

where is pain from the perineal part of the urethra felt

A

localised in the perineum

36
Q

how do visceral afferent nerve fibres get from the kidney to the CNS

A

visceral afferents run along side sympathetic fibres back to the spinal cord

enter spinal cord between T11 and L1

37
Q

why is pain felt in the loin from the kidney

A

because it is the T11-L1 dermatome posteriorly

38
Q

what other things could cause loin pain

A 
skin origin (herpes zoster) 
muscular 
vertebrae 
spinal nerve route compression 
lower lobe pneumonia
39
Q

how do visceral afferents get from ureters to CNS

A

visceral afferents run along side sympathetic fibres back to the spinal cord

enter spinal cord between T11 and L2

40
Q

where is pain from the urethra felt

A

anywhere along the path of the visceral afferents (from ureter up to T11/L2)

41
Q

what are some differentials of groin pain

A

hernias
lymphadenopathy
testicular pathology

42
Q

how do visceral afferent nerve fibres get from bladder to CNS

A

visceral afferents from the top part of the bladder (touching peritoneum) run along side sympathetic nerve fibres

visceral afferents from the rest of the bladder (not touching peritoneum) run along side the parasympathetic nerve fibres to sacral spinal levels S2,3,4

43
Q

what are the differentials of suprapubic pain

A

hind gut organs (sigmoid diverticula)

other single, midline pelvic organs who’s superior aspect touched the peritoneum (uterus)

44
Q

how do visceral afferents get from the proximal urethra to the CNS

A

from the proximal urethra (above levator ani) run along side parasympathetic fibres up to the spinal nerves

45
Q

how do somatic sensory nerve fibres from the remaining urethra get to the CNS

A

carried with the PUDENAL nerve back to the spinal cord levels S2,3,4

pain from this part of the urethra presents as localised within the perineum

46
Q

what are the differential diagnosis’s for perineal pain

A

vaginal tear
anal canal fissure
perineal genital ulcers (herpes)

47
Q

how to visceral afferents get from the testes to CNS

A

run along side sympathetic fibres back to spinal cord level T10-11

(due to embryological descent)

48
Q

why can pain from the testes present as localised to the scrotum and/or groin

A

due to its close relationship to the scrotal wall (body wall)

49
Q

what is the differentials for scrotal pain

A

skin lesions

strangulated inguinal hernia

50
Q

what type of pain comes from the kidney

A

dully achy type pain in loin

51
Q

what type of pain comes from ureters

A

if obstruction ‘loin to groin’ pain

52
Q

what type of pain comes from the bladder

A

dull, achy, suprapubic pain

53
Q

what type of pain comes from the urethra

A

distal urethra - sharp localised pain in the perineum

54
Q

what type of pain comes from the testes

A

often felt in scrotum but can radiate to groin and lower abdomen

55
Q

what spinal cord levels are essential in controlling urine for

A

S2-S4

56
Q

what senses the filling of the bladder

A

stretch receptors at the end of visceral afferent nerve fibres

this info is sent to CNS via S2,3,4 spinal cord levels

57
Q

what happens after the CNS senses a full bladder

A

emptying of bladder by stimulation of detrusor muscle and inhibition of internal urethral sphincter (in males)

58
Q

what gives us the ability to voluntarily control the flow of urine

A

overriding of the reface by inhibitory nerve fibres from the cortex

59
Q

what happens once inhibitors of the reflex to empty the bladder is lifted

A

co-ordinated contraction/relaxation of:

  • detrussor muscle (parasympathetic)
  • internal urethral sphincter (parasympathetic)
  • external urethral sphincter and levator ani muscle (somatic motor)
  • anterolateral abdominal wall muscles (somatic motor)
60
Q

where does the pudenal nerve arise from

A

the sacral plexus

S2,3,4

61
Q

where does the sciatic nerve arise from

A

the sacral plexus

L4-S3

62
Q

what nerves arise from the lumbar plexus that supply the lower limb

A 
iliohypogastric 
ilioinguinal 
lateral cutaneous nerve of the thigh 
genitofemoral 
femoral 
obturator
63
Q

where does the femoral nerve pass after the sacral plexus (L2,3,4)

A

under the inguinal ligament into the anterior compartment of the thigh

64
Q

where does the obturator nerve pass after the sacral plexus (L2,3,4)

A

through the obturator foramen (pelvis) and into the medial compartment fo the thigh

65
Q

where does the sciatic nerve pass after the sacral plexus (L4-S3)

A

into the posterior compartment of the thigh via the gluteal region

66
Q

what does the sciatic nerve split into

A

tibial (posterior compartment of leg and intrinsic muscles of the foot) and common fibular nerves

67
Q

what does the common fibular nerve supply

A

splits into superficial and deep

superficial - lateral compartment of leg

deep - anterior compartment of leg

68
Q

what nerves supplies the plantar aspect of the foot

A

tibial

69
Q

what nerve supplies sensation to the lateral aspect of the foot

A

sural nerve

70
Q

what nerve supplies sensation to the 1st web space of the foot

A

deep fibular

71
Q

what nerve supplies sensation to the dorsal surface of the foot

A

superficial fibular

72
Q

what nerve fibres stimulate detrusor contraction in bladder emptying

A

parasympathetic

73
Q

what nerve fibres stimulate the urethral sphincter control (external) in bladder emptying

A

somatic motor fibres within the pudenal nerve stimulated it to contract

74
Q

what nerve fibres stimulate the internal urethral sphincter control and when (males)

A

sympathetic fibres stimulate internal urethral sphincter contraction (during ejaculation)

parasympathetic relax it in urination to let urine flow through

2 RENAL (20 decks)

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