urinary incontinence - learn

Question 1

Outline the nerve supply for ureteric peristalsis

Answer 1

Sympathetic

Parasympathetic

Question 2

Outline the nerve supply for bladder contraction

Answer 2

Sympathetic

Parasympathetic

Question 3

Outline the nerve supply for urethral sphincter control

Answer 3

INTERNAL: Sympathetic, parasympathetic

EXTERNAL AND LEVATOR ANI: Somatic motor

Question 4

Which areas of the urinary tract are supplied by visceral afferents?

Answer 4

Kidneys
Ureters
Bladder
Urethra
Testis

Question 5

Which areas of the urinary tract are supplied by somatic sensory nerves?

Answer 5

Urethra

Testis

Question 6

What is the nerve supply used for voluntary control of elimination from the bladder?

Answer 6

Sympathetic
Parasympathetic
Somatic motor
Visceral afferent

Question 7

What is the nerve supply to the perineum?

Answer 7

Somatic sensory

Somatic motor

Question 8

What type of nerve fibre supplies sensory innervation to the soma?

Answer 8

Somatic sensory fibres

Question 9

What type of nerve fibre supplies sensory innervation to the viscera?

Answer 9

Visceral afferent fibres

Question 10

What type of nerve fibre supplies motor innervation to the soma?

Answer 10

Somatic motor fibres

Question 11

What type of nerve fibre supplies motor innervation to the viscera?

Answer 11

Sympathetic fibres

Parasympathetic fibres

Question 12

The sympathetic fibres leave the CNS via spinal nerves between what vertebral levels? What is this known as?

Answer 12

T1-L2

Thoracolumbar outflow

Question 13

Sympathetic fibres reach SM/ glands of body wall via…

Answer 13

Spinal nerves

Question 14

Sympathetic fibres reach SM/ glands of body via…

Answer 14

Cardiopulmonary or abdominopelvic splanchic nerves

Question 15

Sympathetic fibres reach SM/ glands of head via…

Answer 15

Hitching a ride with arteries that supply the structure

Question 16

Sympathetic chains run the entire length of the vertebral column. True/ False?

Answer 16

True

Question 17

Outline the route taken by sympathetic nerves from the CNS to the KUB

Answer 17

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

Question 18

What is a periarterial plexus?

Answer 18

Collection of nerve fibres on outside of arteries

Question 19

How do parasympathetic fibres leave the CNS? What is this known as?

Answer 19

CNs III, VII, IX, X and sacral spinal nerves

Craniosacral outflow

Question 20

Parasympathetic nerves do not innervate…

Answer 20

SM/glands of body wall

Question 21

Parasympathetic fibres reach the SM/ glands of head via…

Answer 21

Cranial nerves

Question 22

Parasympathetic fibres reach the hindgut and pelvic organs via…

Answer 22

Pelvic splanchic nerves

Question 23

How do parasympathetic fibres travel from the CNS to the KUB?

Answer 23

Kidneys and ureter: Vagus nerve

Bladder: S2,3,4 spinal nerves –> Pelvic splanchic nerves

Question 24

How do somatic nerve fibres travel from the CNS to the KUB?

Answer 24

Don’t travel to these structures only to the body wall and perineum (urethra and sphincter)

Question 25

Describe pain coming from the kidneys

Answer 25

Dull achy pain in the loin

Question 26

Describe pain coming from the bladder

Answer 26

Dull achy suprapubic pain

Question 27

Describe pain coming from ureteric calculi

Answer 27

Loin to groin pain

Question 28

Describe pain coming from the perineal urethra

Answer 28

Localised sharp pain in perineum

Question 29

How do visceral afferent nerve fibres travel from the kidneys to the CNS?

Answer 29

Run along sympathetic fibres back to spinal cord entering between T11 and L1

Question 30

How do visceral afferent nerve fibres travel from the ureters to the CNS?

Answer 30

Run along sympathetic fibres back to the spinal cord entering between T11 and L2

Question 31

How do visceral afferent nerve fibres travel from the bladder to the CNS?

Answer 31

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

Question 32

How do visceral afferent nerve fibres travel from the urethra to the CNS?

Answer 32

``` PROXIMAL URETHRA (above levator ani): Run along parasympathetic fibres back to spinal cord entering at levels S2,3,4 ```

Question 33

How do somatic sensory nerve fibres travel from the urethra to the CNS?

Answer 33

DISTAL URETHRA: | Run along pudenal nerve back to spinal cord entering at levels S2,3,4

Question 34

How do visceral afferent nerve fibres travel from the testis to the CNS?

Answer 34

Run along sympathetic fibres back to spinal cord entering between T10 and T11

Question 35

Nerve fibres controlling urine flow enter and leave the spinal cord between what levels?

Answer 35

S2,3,4

Question 36

List the nerve fibres involved in controlling urine flow

Answer 36

Visceral afferent fibres Pelvis splanchic nerves (parasympathetic) Pudenal nerves (somatic motor and sensory)

Question 37

Outline the five stages of urine flow

Answer 37

1. As bladder flows, sensed by stretch receptors at end of visceral afferent fibres 2. Information is transmitted to CNs via S2,3,4 spinal cord levels 3. Reflex to empty bladder via detrusor muscle and inhibition of internal sphincter muscles 4. 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 5. During micturation, cerebral inhibition of this reflex is lifted, followed by coordinated contraction and relaxation

Question 38

During micturation, which muscles are contracted?

Answer 38

Anterolateral abdominal wall muscles | Detrusor muscle

Question 39

During micturation, which muscles are relaxed?

Answer 39

Internal urethral sphincter External urethral sphincter Levator ani

Question 40

What are nerve plexuses?

Answer 40

A collection of named nerves from the body wall formed from the anterior ramii of spinal nerves

Question 41

List the named nerves of the sacral plexus and the areas they supply

Answer 41

``` Pudenal nerve (perineum) Sciatic nerve --> Common fibular nerve (superficial for lateral leg, deep for anterior leg, tibial branch for posterior leg and intrinsic foot) ```

Question 42

List the named nerves of the lumbar plexus and the areas they supply

Answer 42

``` 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) ```

Question 43

State the nerve roots the pudenal nerve is derived from

Answer 43

S2,3,4

Question 44

State the nerve roots the sciatic nerve is derived from

Answer 44

L4-S3

Question 45

State the nerve root the iliohypogastric nerve is derived from

Answer 45

L1

Question 46

State the nerve root the ilioinguinal nerve is derived from

Answer 46

L1

Question 47

State the nerve roots the lateral cutaneous nerve of the thigh is derived from

Answer 47

L2,3

Question 48

State the nerve roots the femoral nerve is derived from

Answer 48

L2,3,4

Question 49

State the nerve roots the genitofemoral nerve is derived from

Answer 49

L1,2

Question 50

State the nerve roots the obturator nerve is derived from

Answer 50

L2,3,4