urinary incontinence - learn Flashcards
Outline the nerve supply for ureteric peristalsis
Sympathetic
Parasympathetic
Outline the nerve supply for bladder contraction
Sympathetic
Parasympathetic
Outline the nerve supply for urethral sphincter control
INTERNAL: Sympathetic, parasympathetic
EXTERNAL AND LEVATOR ANI: Somatic motor
Which areas of the urinary tract are supplied by visceral afferents?
Kidneys Ureters Bladder Urethra Testis
Which areas of the urinary tract are supplied by somatic sensory nerves?
Urethra
Testis
What is the nerve supply used for voluntary control of elimination from the bladder?
Sympathetic
Parasympathetic
Somatic motor
Visceral afferent
What is the nerve supply to the perineum?
Somatic sensory
Somatic motor
What type of nerve fibre supplies sensory innervation to the soma?
Somatic sensory fibres
What type of nerve fibre supplies sensory innervation to the viscera?
Visceral afferent fibres
What type of nerve fibre supplies motor innervation to the soma?
Somatic motor fibres
What type of nerve fibre supplies motor innervation to the viscera?
Sympathetic fibres
Parasympathetic fibres
The sympathetic fibres leave the CNS via spinal nerves between what vertebral levels? What is this known as?
T1-L2
Thoracolumbar outflow
Sympathetic fibres reach SM/ glands of body wall via…
Spinal nerves
Sympathetic fibres reach SM/ glands of body via…
Cardiopulmonary or abdominopelvic splanchic nerves
Sympathetic fibres reach SM/ glands of head via…
Hitching a ride with arteries that supply the structure
Sympathetic chains run the entire length of the vertebral column. True/ False?
True
Outline the route taken by sympathetic nerves from the CNS to the KUB
Leave spinal cord between T10-L2
–> Sympathetic chains
–> Abdominopelvic splanchic nerves
–> Synapse at abdominal sympathetic ganglia
–> Post-synaptic nerve onto surface of arteries
towards organs
What is a periarterial plexus?
Collection of nerve fibres on outside of arteries
How do parasympathetic fibres leave the CNS? What is this known as?
CNs III, VII, IX, X and sacral spinal nerves
Craniosacral outflow
Parasympathetic nerves do not innervate…
SM/glands of body wall
Parasympathetic fibres reach the SM/ glands of head via…
Cranial nerves
Parasympathetic fibres reach the hindgut and pelvic organs via…
Pelvic splanchic nerves
How do parasympathetic fibres travel from the CNS to the KUB?
Kidneys and ureter: Vagus nerve
Bladder: S2,3,4 spinal nerves –> Pelvic splanchic nerves
How do somatic nerve fibres travel from the CNS to the KUB?
Don’t travel to these structures only to the body wall and perineum (urethra and sphincter)
Describe pain coming from the kidneys
Dull achy pain in the loin
Describe pain coming from the bladder
Dull achy suprapubic pain
Describe pain coming from ureteric calculi
Loin to groin pain
Describe pain coming from the perineal urethra
Localised sharp pain in perineum
How do visceral afferent nerve fibres travel from the kidneys to the CNS?
Run along sympathetic fibres back to spinal cord entering between T11 and L1
How do visceral afferent nerve fibres travel from the ureters to the CNS?
Run along sympathetic fibres back to the spinal cord entering between T11 and L2
How do visceral afferent nerve fibres travel from the bladder to the CNS?
PART THAT TOUCHES PERITONEUM (SUPERIOR):
Run along sympathetic fibres back to spinal cord entering beteen T11 and L2
REST OF BLADDER:
Run along parasympathetic fibres back to spinal cord entering at levels S2,3,4
How do visceral afferent nerve fibres travel from the urethra to the CNS?
PROXIMAL URETHRA (above levator ani): Run along parasympathetic fibres back to spinal cord entering at levels S2,3,4
How do somatic sensory nerve fibres travel from the urethra to the CNS?
DISTAL URETHRA:
Run along pudenal nerve back to spinal cord entering at levels S2,3,4
How do visceral afferent nerve fibres travel from the testis to the CNS?
Run along sympathetic fibres back to spinal cord entering between T10 and T11
Nerve fibres controlling urine flow enter and leave the spinal cord between what levels?
S2,3,4
List the nerve fibres involved in controlling urine flow
Visceral afferent fibres
Pelvis splanchic nerves (parasympathetic)
Pudenal nerves (somatic motor and sensory)
Outline the five stages of urine flow
- As bladder flows, sensed by stretch receptors at end of visceral afferent fibres
- Information is transmitted to CNs via S2,3,4 spinal cord levels
- Reflex to empty bladder via detrusor muscle and inhibition of internal sphincter muscles
- In potty trained individuals, the brain overrides this reflex and an AP in inhibitory nerve fibres passes from the cortex causing voluntary contraction of EUS and levator ani
- During micturation, cerebral inhibition of this reflex is lifted, followed by coordinated contraction and relaxation
During micturation, which muscles are contracted?
Anterolateral abdominal wall muscles
Detrusor muscle
During micturation, which muscles are relaxed?
Internal urethral sphincter
External urethral sphincter
Levator ani
What are nerve plexuses?
A collection of named nerves from the body wall formed from the anterior ramii of spinal nerves
List the named nerves of the sacral plexus and the areas they supply
Pudenal nerve (perineum) Sciatic nerve --> Common fibular nerve (superficial for lateral leg, deep for anterior leg, tibial branch for posterior leg and intrinsic foot)
List the named nerves of the lumbar plexus and the areas they supply
Iliohypogastric nerve (lateral glutes) Ilioinguinal nerve (perineum) Lateral cutaneous nerve (lateral thigh) Femoral nerve (lateral to psoas major, anterior thigh) Genitofemoral nerve (surface of psoas) Obturator nerve (medial to psoas major, medial thigh)
State the nerve roots the pudenal nerve is derived from
S2,3,4
State the nerve roots the sciatic nerve is derived from
L4-S3
State the nerve root the iliohypogastric nerve is derived from
L1
State the nerve root the ilioinguinal nerve is derived from
L1
State the nerve roots the lateral cutaneous nerve of the thigh is derived from
L2,3
State the nerve roots the femoral nerve is derived from
L2,3,4
State the nerve roots the genitofemoral nerve is derived from
L1,2
State the nerve roots the obturator nerve is derived from
L2,3,4