Urinary Continence and Renal System Pain Flashcards
what are the motor functions of the renal system
Ureteric peristalsis
Bladder contraction
Urethral sphincter control (internal and external urethral sphincters)
where is pain sensed in the renal system
kidney pain ureter pain bladder pain urethra pain pain from testes - not technically renal
what is urinary continence
the voluntary control of the elimination of urine from the bladder
this is a motor and sensory function
where does the lumbar and sacral plexus give innervation to (motor and sensory)
perineum (distal part of renal system)
lower limbs
what nerve fibres convey sensations from the body wall to the CNS
somatic sensory
soma meaning wall
what nerve fibres convey sensations from the viscera (organs) to the CNS
visceral afferent nerve fibres
afferent - towards brain
what nerve fibres stimulate movement in the body wall from the CNS
somatic motor
stimulate skeletal muscle voluntarily to contract
what nerve fibres stimulate movement in internal organs from the CNS
parasympathetic nerve fibres OR sympathetic move fibres
sympathetic stimulate smooth muscle, cardiac muscle or glands
what nerve fibres control ureteric peristalsis
sympathetic/parasympathetic
what nerve fibres control bladder contraction
sympathetic/parasympathetic
what nerve fibres control internal and external urethral sphincter control
sympathetic/parasympathetic (internal sphincter in males)
somatic motor (external sphincter and levaor ani)
what nerves sense pain in the urethra
visceral afferent in the pelvis
somatic sensory in the perineum
how do nerves communicated with CNS
via either cranial nerves or spinal nerves
what types of nerves are carried the entire length of spinal/cranial nerves
somatic motor
somatic sensory
how do sympathetic and parasympathetic nerves and visceral afferents make use of the cranial/spinal nerves
travel along them for limited portions to get in and out of CNS
where do sympathetic nerve fibres leave the spinal cord
only within the spinal nerves between spinal cord levels
T1-L2
(thoracolumbar)
how do sympathetic fibres reach the smooth muscle/glands of the body wall
from within the spinal nerves
how do sympathetic fibres reach the smooth muscle/glands of the body (other than the wall)
through splanchnic nerves (cardiopulmonary or abdominopelvic)
how do sympathetic fibres reach the smooth muscle/glands of the head
by ‘hitching a ride’ with arteries supplying the same structure
what do sympathetic fibres do
supply motor innervation to smooth muscle, cardiac muscle and glands in the body
what fibres do the spinal nerves carry
somatic motor
somatic sensory
sympathetic fibres
how many spinal nerves are there
31 pairs
how many cranial nerves are there
12 pairs
where does the sympathetic chain run
entire length of the vertebral column
how do sympathetic nerve fibres get from the CNS to the kidneys, ureters and bladder
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
what is the collection of nerve fibres found on the outside of arteries called
periarterial plexus
what nerve fibres (other than sympathetic) are in periarterial plexuses
parasympathetic
visceral afferent
(bc they all go to/come back from the same organ)
how do parasympathetic nerve fibres reach the hindgut and pelvic organs
pelvic splanchnic nerves
how do parasympathetic fibres reach the smooth muscle/glands of the head
via cranial nerves
III, VII, IX and X
how do parasympathetic nerve fibres get from the CNS to the kidneys, ureters and bladder
carried within the VAGUS nerve to kidneys and ureter
carried with pelvic splanchnic nerves to bladder
what part of the renal system do somatic motor nerves go to
the perineum
(eg, urethral distal to pelvic floor and its sphincter) as there’s are part of the body wall
where can pain from a calculus in the ureter be filled
‘loin to groin’ on addicted side
where can pain from the kidney itself be felt (eg. in acute hydronephrosis)
the loin
posterior aspect of the flank region on the affected side
where is pain from the bladder felt
in the suprapubic region (midline)
where is pain from the perineal part of the urethra felt
localised in the perineum
how do visceral afferent nerve fibres get from the kidney to the CNS
visceral afferents run along side sympathetic fibres back to the spinal cord
enter spinal cord between T11 and L1
why is pain felt in the loin from the kidney
because it is the T11-L1 dermatome posteriorly
what other things could cause loin pain
skin origin (herpes zoster) muscular vertebrae spinal nerve route compression lower lobe pneumonia
how do visceral afferents get from ureters to CNS
visceral afferents run along side sympathetic fibres back to the spinal cord
enter spinal cord between T11 and L2
where is pain from the urethra felt
anywhere along the path of the visceral afferents (from ureter up to T11/L2)
what are some differentials of groin pain
hernias
lymphadenopathy
testicular pathology
how do visceral afferent nerve fibres get from bladder to CNS
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
what are the differentials of suprapubic pain
hind gut organs (sigmoid diverticula)
other single, midline pelvic organs who’s superior aspect touched the peritoneum (uterus)
how do visceral afferents get from the proximal urethra to the CNS
from the proximal urethra (above levator ani) run along side parasympathetic fibres up to the spinal nerves
how do somatic sensory nerve fibres from the remaining urethra get to the CNS
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
what are the differential diagnosis’s for perineal pain
vaginal tear
anal canal fissure
perineal genital ulcers (herpes)
how to visceral afferents get from the testes to CNS
run along side sympathetic fibres back to spinal cord level T10-11
(due to embryological descent)
why can pain from the testes present as localised to the scrotum and/or groin
due to its close relationship to the scrotal wall (body wall)
what is the differentials for scrotal pain
skin lesions
strangulated inguinal hernia
what type of pain comes from the kidney
dully achy type pain in loin
what type of pain comes from ureters
if obstruction ‘loin to groin’ pain
what type of pain comes from the bladder
dull, achy, suprapubic pain
what type of pain comes from the urethra
distal urethra - sharp localised pain in the perineum
what type of pain comes from the testes
often felt in scrotum but can radiate to groin and lower abdomen
what spinal cord levels are essential in controlling urine for
S2-S4
what senses the filling of the bladder
stretch receptors at the end of visceral afferent nerve fibres
this info is sent to CNS via S2,3,4 spinal cord levels
what happens after the CNS senses a full bladder
emptying of bladder by stimulation of detrusor muscle and inhibition of internal urethral sphincter (in males)
what gives us the ability to voluntarily control the flow of urine
overriding of the reface by inhibitory nerve fibres from the cortex
what happens once inhibitors of the reflex to empty the bladder is lifted
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)
where does the pudenal nerve arise from
the sacral plexus
S2,3,4
where does the sciatic nerve arise from
the sacral plexus
L4-S3
what nerves arise from the lumbar plexus that supply the lower limb
iliohypogastric ilioinguinal lateral cutaneous nerve of the thigh genitofemoral femoral obturator
where does the femoral nerve pass after the sacral plexus (L2,3,4)
under the inguinal ligament into the anterior compartment of the thigh
where does the obturator nerve pass after the sacral plexus (L2,3,4)
through the obturator foramen (pelvis) and into the medial compartment fo the thigh
where does the sciatic nerve pass after the sacral plexus (L4-S3)
into the posterior compartment of the thigh via the gluteal region
what does the sciatic nerve split into
tibial (posterior compartment of leg and intrinsic muscles of the foot) and common fibular nerves
what does the common fibular nerve supply
splits into superficial and deep
superficial - lateral compartment of leg
deep - anterior compartment of leg
what nerves supplies the plantar aspect of the foot
tibial
what nerve supplies sensation to the lateral aspect of the foot
sural nerve
what nerve supplies sensation to the 1st web space of the foot
deep fibular
what nerve supplies sensation to the dorsal surface of the foot
superficial fibular
what nerve fibres stimulate detrusor contraction in bladder emptying
parasympathetic
what nerve fibres stimulate the urethral sphincter control (external) in bladder emptying
somatic motor fibres within the pudenal nerve stimulated it to contract
what nerve fibres stimulate the internal urethral sphincter control and when (males)
sympathetic fibres stimulate internal urethral sphincter contraction (during ejaculation)
parasympathetic relax it in urination to let urine flow through
