Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Semester 3 > Urinary Session 8 > Flashcards

Urinary Session 8 Flashcards

1
Q

Why are reflexes involved in micturition said to be modified?

A

Due to brain involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which phase do sympathetic neurones control in micturition?

A

Storage phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which phase do parasympathetic neurones control in micturition?

A

Voiding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which neurones control continence?

A

T10-L2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which neurones control micturition?

A

S2-4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Why is the bladder described as an autonomic effector?

A

It has no inherent activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Where does the bladder derive from?

A

Embryonic hindgut

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What determines all activity in the bladder?

A

ANS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Is the bladder operated equally by the autonomic and somatic nervous systems?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which two bi-stable states does the bladder occupy with no state in between?

A

Storage and voiding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is detrusor muscle?

A

Plexiform network of smooth muscle cells arranged in inner longitudinal, middle circular and outer longitudinal layers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Why is detrusor muscle arranged in three different orientations?

A

Confer strength irrespective of direction of stretch so filling is uniform

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Where does the neural supply of detrusor muscle come from?

A

Bilaterally from the spinal cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Is bladder pain well or poorly localised?

A

Well

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Why are there many different options for Tx of bladder function disorders?

A

Different anatomical components are supplied by different divisions of the nervous system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What causes detrusor muscle to be a mass contracting muscle?

A

Lack of gap junctions and peristaltic activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Why is the submucosa in the bladder not a true submucosa?

A

Epithelium is non-secretory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Can mucus in the urine have originated from the bladder?

A

No, epithelium is non-secretory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Does the bladder vary much in size and shape between the two sexes?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is micturition?

A

The desire to pass urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How does the trigone differ from the surrounding detrusor muscle?

A

Endoderm derivative

Has very sensitive neurones which detect stretch to stimulate voiding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What neural control is the body of the bladder under?

A

Reflex via sympathetic and parasympathetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Is the internal urethral sphincter a true sphincter?

A

No, it is physiological

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Is the external urethral sphincter a true sphincter?

A

Yes, it is an anatomical sphincter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How is the external urethral sphincter formed?

A

In the urogenital diaphragm by pelvic floor muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What type of control is exerted on the external urethral sphincter?

A

Somatic - voluntary from cerebral cortex –> spinal cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the layers of the bladder wall from lumen outwards?

A 
Urothelium
Lamina propria
Submucosa
Detrusor muscle
Adventitia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What forms the mucosa of the bladder?

A

Urothelium
Lamina propria
Nerves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What can be said about the control of micturition?

A

It is entirely spinal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What type of receptor do pelvic nerves under parasympathetic control act on in the bladder?

A

M3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What type of receptors do hypogastric nerves under sympathetic control act on in the bladder and bladder neck?

A

Bladder: beta-3

Bladder neck: alpha-1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What receptor does the pudendal nerve under sympathetic control act on in the external urethral sphincter?

A

Nicotinic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Which receptors expressed in the urinary bladder are under stimulators action and which are under inhibitory action?

A

Stimulatory: M3, alpha-1, nicotinic
Inhibitory: beta-3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

How is the ANS innervation of the bladder described with reference to its sympathetic and parasympathetic inputs?

A

Antagonistic pairing of inputs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Why is the continence phase not indefinite?

A

Bladder wall is permeable to toxins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

How does damage to continence neurones lead to urinary incontinence?

A

Damage to neurones –> failure of storage –> decreased bladder capacity –> frequency of micturition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are the neuronal events in the continence phase of micturition?

A

Cerebral cortex –> Pontine continence centre –> sympathetic nuclei in spinal cord –> detrusor muscle and external sphincter motor neurones in sacral cord –> continence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is the action from the bilateral outputs of the Pons as they descend without crossing over from the Pontine continence centre?

A

Silence detrusor electrical activity
Relax detrusor via beta-3 in fundus
Increase urethral sphincteric pressure via alpha-1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

How does the sympathetic nervous system spinal centre of continence act on the bladder?

A

Relaxes detrusor muscles via beta-3

Constructs bladder neck via alpha-1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

How does the somatic nervous system spinal continence centre act in the continence phase?

A

Closes external urethral sphincter via ACh action at NMJ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Which spinal root values are in the sympathetic spinal continence control centre?

A

T10-L2

42
Q

Which spinal nerve root values are involved in the somatic spinal continence centre?

A

S2-4

43
Q

Where is the somatic spinal continence centre found?

A

Onuf’s nucleus in the ventral horn

44
Q

What other sphincter is controlled by Onuf’s nucleus in the ventral horn?

A

Anal sphincter

45
Q

What is the neural apparatus for urinary storage known as?

A

Continence circuits

46
Q

What is the capacity of the bladder?

A

300-700 ml

47
Q

At what volume will there be back flow of urine from the bladder into the ureters?

A

None, this does not occur

48
Q

What does the trigone continuously monitor in the bladder?

A

Ionic composition of urine
Temperature
Volume via stretch

49
Q

Describe the stress-relaxation phenomenon.

A

As the bladder fills rugae flatten so intra-vesical pressure is constant

50
Q

What happens when the bladder fills by ~400 ml?

A

Afferent nerve in wall detect stretch and signal void via parasympathetic and some sympathetic nerves

51
Q

How can a beta-3 agonist be used to treat urinary incontinence?

A

Increases capacity to store urine by activating receptors which cause relaxation of detrusor muscle in the fundus and body

52
Q

What is the result of damage to micturition neurones?

A

Failure to pass urine –> urinary retention

53
Q

When is urine passed involuntarily?

A

In overflow incontinence when bladder is overfilled

54
Q

Disturbances to what lead to detrusor-sphincter dyssenergia?

A

Coordinated and opposite activity of bladder and external urethral sphincter

55
Q

What is the micturition phase mediated by?

A

Voiding circuits

56
Q

What are the neuronal events in control of the micturition phase?

A

Cerebral cortex –> M-region of Pons –> sacral levels of parasympathetic outflow –> detrusor muscle contracts and internal sphincter relaxes –> external urethral sphincter relaxes –> void acne

57
Q

Where is the Pontine continence centre found?

A

L-region of Pons

58
Q

Where do the ANS sacral nerves involved in controlling voiding centres arise from?

A

Lateral horn

59
Q

What somatic spinal root values cause relaxation of the external sphincter?

A

S2-4 in the ventral horn

60
Q

What neuronal activity causes increased detrusor activity?

A

Bilateral parasympathetic division of ANS from lateral horn of S2-4

61
Q

How does the mediation of spinal control centres compare between the continence and micturition phases?

A

Continence: exclusively by sympathetic neurones of spinal cord
Micturition: exclusively by parasympathetic neurones of sacral spinal cord

62
Q

What is another name for the M-region of the Pons?

A

Barrington’s nucleus

63
Q

Why do sensation and voiding in the bladder not need to be under conscious control?

A

There is no sensory or motor representation of the bladder in the respective cortexes

64
Q

What gives neural supply to the external urethral sphincter?

A

Perineal branch of Pudendal nerve, S2-4 from ventral horn

65
Q

What can cause decreased compliance in the bladder leading to incomplete filling?

A

Scarring e.g. in TB or radiotherapy

66
Q

What can increase the sensation of bladder filling when the volume does not correspond?

A

Stone
UTI
Tumour

67
Q

What are the consequences of a lower motor neurone lesion affecting S2-4?

A

Decreased detrusor pressure
Decreased perianal sensation
Lax anal tone

68
Q

What is the presentation of a pt with a lower motor neurone lesion of S2-4 likely to be?

A

Painless increasing waistline due to chronic retention +/- overflow incontinence is volume is large

69
Q

What are the consequences of an upper motor neurone lesion affecting the spinal cord control of micturition?

A

Hypertrophical detrusor muscle –> increased pressure contractions –> dilated ureters due to high intravesical pressure –> decreased kidney function –> poor coordination of bladder with sphincters –> detrusor muscle dyssenergia

70
Q

What storage lower urinary tract symptoms can pts present with?

A

Frequency
Urgency
Naturia
Incontinence

71
Q

What voiding lower urinary tract symptoms can pts present with?

A 
Slow stream
Splitting/spraying
Intermittency
Hesitancy
Straining
Terminal dribble
72
Q

What post-micturition lower urinary tract symptoms can pts present with?

A

Post-micturition dribble

Feeling of incomplete emptying

73
Q

What is urinary incontinence?

A

Complaint of any involuntary leakage of urine

74
Q

What are the effects of urinary incontinence on the pt?

A

Decreased QoL
Social exclusion
Sense of shame

75
Q

What are the four types of urinary incontinence?

A

Stress
Urge
Mixed
Overflow

76
Q

What is stress urinary incontinence?

A

Involuntary leakage on increase of intra-abdominal pressure e.g. effort, exertion, cough, sneeze

77
Q

When does stress in continence most commonly arise?

A

After childbirth

78
Q

What accounts for 50% of all cases of urinary incontinence?

A

Stress incontinence

79
Q

How is stress urinary incontinence treated?

A

Pelvic floor muscle training
Duloxetine
Surgery

80
Q

What is Duloxetine?

A

Combined NA and serotonin uptake inhibitor which increases activity of external urethral sphincter during continence stage

81
Q

Why is Duloxetine not used as a first line Tx for stress incontinence?

A

Can cause severe nausea

82
Q

What types of surgery can be used to treat stress incontinence?

A

Females: low-tension vaginal tapes, open retropubic suspension, classical sling
Males: artificial urinary sphincter, male sling

83
Q

What temporary treatment can be used to treat stress incontinence when the pt plans to have further pregnancies?

A

Intramural bulking agents

84
Q

What is urge urinary incontinence?

A

Involuntary leakage accompanied by/immediately preceded by urgency

85
Q

How common is urge incontinence in urinary incontinence pts?

A

Accounts for 20% of cases

86
Q

How is urge incontinence treated?

A 
Bladder training with scheduled voiding
Anticholinergics to act on M2&3
Beta-3 agonist
Botulinum toxin to inhibit ACh release
Surgery
87
Q

What surgical procedures can be used to Tx urge incontinence?

A

Sacral nerve neuromodulation (stimulation via implant)
Remove detrusor muscle (autoaugmentation)
Use bowel to increase bladder volume
Urinary diversion

88
Q

What is mixed urinary incontinence?

A

Involuntary leakage associated with urgency and exertion/coughing etc

89
Q

When does overflow in continence typically occur?

A

At night when neural control of bladder is reduced

90
Q

Why is overflow incontinence painless?

A

Bladder is under active

91
Q

Describe faecal overflow incontinence.

A

Constipation causes soft stool to move around obstruction

92
Q

What is overactive bladder syndrome?

A

Includes MUI and UUI and is characterised by urgency, frequency and nocturia

93
Q

What are obstetric and gynaecological risk factors for urinary incontinence?

A

Pregnancy and childbirth
Pelvic surgery
Radiotherapy
Pelvic prolapse

94
Q

Give some examples of predisposing risk factors for urinary incontinence.

A

Race
FHx
Anatomical/neurological abnormalities

95
Q

Give some promoting risk factors for urinary incontinence.

A 
Menopause
Drugs
UTI
Increased intra-abdominal pressure
Cognitive impairment
Age
Co-morbidities
96
Q

Why is the menopause a promoting factor for urinary incontinence?

A

Drying vagina increases likelihood of developing UTI

97
Q

How is the type of urinary incontinence identified by history?

A

Overactive bladder (MUI or UUI) will not be stimulated by coughing

98
Q

Why is urine dipstick a mandatory investigation for urinary incontinence?

A

Identify UTI, haematuria (malignancy), proteinuria or glucosuria causing polyuria which will present as frequency

99
Q

What are basic non-invasive urodynamics?

A

Measurements of fluid intake and exit over time or measurement of post-micturition residual volume by US

100
Q

What optional investigations can be preformed in urinary incontinence?

A

Invasive urodynamics for pressure-flow studies
Pad tests
Cystoscopy

101
Q

What general lifestyle interventions can be used to manage urinary incontinence?

A 
Modify fluid intake
Weightloss
Smoking cessation
Decrease caffeine intake esp. UUI
Avoid constipation
Fixed voiding schedule
102
Q

What are the management options for urinary in continence pts who cannot have surgery and are not responding to conservative/medical Tx or have

A

Contained incontinence via indwelling catheter (urethral/suprapubic), sheath device (adhesive condom attached to catheter), incontinence pads

Semester 3 (50 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions