Urinary Function (PKenny) Flashcards

1
Q

where does neurological control of the bladder originate?

A
Lumbosacral spine
- L1-L4, S1-S3
> hypogastric n. (L1-L4)
> pelvic n. (S1 - S3) 
> pudendal n. (S1-S3)
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2
Q

What is the bladder and urethra made up of/controlled by?

A
> Bladder
- detrusor m. (smooth m)
> urethra 
- internal urethral sphincter (smooth m)
- external urethral sphincter (skeletal m) controlled by pudendal n.
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3
Q

Where is the micturition centre located?

A

Pons

- receives input from cerebrum too

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4
Q

What NTs control the micturition reflex?

A
  1. storage phase (sympathetic)
    - bladder relaxed (B adrenergic Rs of hypogastric)
    - urethra contracted (A adrenergic Rs of hypogastric and nicotinic cholinergic Rs of pudendal n)
    + inhibition of parasympathetic
  2. voiding phase (parasympathetic)
    - bladder contraction (Ach muscarinic cholinergic Rs of pelvic n.)
    - relaxation of the urethra d/t lack of symp tone
    + inhibition of sympathetic fibres
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5
Q

What is UMN bladder?

A

Lesion anywhere from pons - L7

  • UMN inhibition lost -> ^ tone
  • turgid easily palpable bladder
  • ^ urinary sphincter tone
  • may be some overflow leakage
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6
Q

What is LMN bladder?

A

Lesion sacral SC or sacral nn. (seen with cauda equina syndrome)

  • v tone
  • flaccid, hard to palpate bladder
  • v urinary sphincter tone
  • passive leakage of urine
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7
Q

Problems associated with neurogenic bladder dysfunction?

A
  • ncontinence
  • urine scald
  • urine stasis -> UTI -> pyelonephritis
  • detrusor atony d/t over stretching of sm. m. tight junctions
  • pain
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8
Q

How can voluntary micturition be distinguished from overflow?

A

Palpate bladder

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9
Q

Management of neurogenci bladder dysfunction

A
> physical management usually necesary 
- manual expression 
- urethral catheterisation (indwelling or permenetn)
- cystotomy tube (long term) 
> pharmacological manipulation 
- to assist manual
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10
Q

Give 5 drugs used to manipulate bladder function and their mechanisms of action

A

> diazepam
- centrally acting muscle relaxant
- v external urethral tone
- give 1 hr pre expressing bladder
Bethanechol (?? off market now?)
- muscarinic cholinergic agonist (parasympathomimetic)
- facilitates detrusor muscle contractility
- do not give if ^ urethral tone will -> rupture
Phenoxybenzamine and Prazosin
- a-adrenergic antagonist
- v internal urethral sphincter tone
- can use in conjunction with Bethanechol
Phenylpropanolamine (PPA)
- mixed a+b adrenergic agonist
- ^ internal urethral sphincter tone
- tx of incontinence rather than urine retention

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11
Q

What does ^ protein in a CSF tap indicate?

A

Non specific sign

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12
Q

How can caudal sacral lesions be differentiated from nerve roots?

A

Cant really - v difficult

- could be L7-cauda equina or spinal n roots

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