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URI > Urination > Flashcards

Urination Flashcards

1
Q

How is urine transported from the kidneys to the bladder?

A
  • Via ureters, peristalsis
  • Locally regulated smooth muscle
  • Low pressure in renal pelvis
  • Also passive due to constant pressure from urine produced in kidney
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2
Q

Define micturition

A

The normal process of passive storage and active voiding of urine
- What happens to the urine after the kidneys

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3
Q

How is retrograde flow back up the ureters prevented?

A
  • Ureters enter at oblique angle to bladder
  • As bladder fills, closes off the ureters
  • However, retrograde flow can occur while in ureters although is prevented by peristalsis and constant pressure from kidneys
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4
Q

What type of muscle is present in the bladder and urethra?

A
  • Bladder: smooth muscle

- Urethra: smooth and skeletal muscle

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5
Q

What is the main function of sympathetic innervation to the bladder?

A
  • Storage

- Contracts internal sphincter preventing passage of urine

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6
Q

Where is the detrusor muscle?

A
  • Network of smooth muscle fibres within bladder wall
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7
Q

What is the innervation to the detrusor muscle?

A
  • Sympathetic and parasympathetic
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8
Q

Describe the internal urethal spincter

A
  • Thickening of bladder muscularture
  • Smooth muscle
  • Sympathetic supply
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9
Q

Describe the external urethral sphincter

A
  • Striated muscle fibres
  • Under voluntary control of somatic nervous system
  • Also used in storage
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10
Q

Describe the function of the sensory innervation to the bladder

A
  • Stretch sensitive
  • Nerve endings in bladder wall
  • Indicate level of filling
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11
Q

What types of motor innervation are involved in micturition?

A
  • Somatic
  • Parasympathetic
  • Sympathetic
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12
Q

Describe the somatic innervation of micturition (outflow, synapse, what it innervates, function)

A
  • Outflow S1-2 (pudendal nerve)
  • No synapse
  • Innervates urethral skeletal muscle (external urethral sphincter)
  • Function is to retain urine
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13
Q

Describe the parasympathetic supply to the bladder (outflow, synapse, what it innervates, neurotransmitterfunction)

A
  • Outflow S1-3 (pelvic plexus)
  • Synapse: pelvic plexus or bladder wall
  • Innervates detrusor muscle
  • ACh
  • Excitatory, empty bladder
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14
Q

Describe the sympathetic supply to the detrusor muscle (outflow, synapse, neurotransmitter, receptor, function)

A
  • Outflow: L1-4
  • Synapse: caudal mesenteric ganglion (or occasionally bladder wall)
  • Norepinephrine
  • Beta receptor
  • Inhibitory, allow bladder filling
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15
Q

Describe the sympathetic supply to the internal sphincter muscle (outflow, synapse, neurotransmitter, receptor, function)

A
  • Outflow: L1-4
  • Synapse: caudal mesenteric ganglion
  • Norepinephrine
  • Alpha-receptors
  • Excitatory, retains urine and increases urethral tone
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16
Q

What is the significance of the sympathetic outflow to the bladder and internal sphincter?

A
  • Same outflow

- Allows excitation of sphincter and relaxation of detrusor to allow urine storage

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17
Q

Describe the central connections involved in the innervation of the bladder

A
  • Control at pons and cerebral cortex
  • Some postulated control from cerebellum
  • Some bladder function local (within spinal cord) , some cerebrocortical input
  • Cerebral input allows control of all the processes
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18
Q

What is the detrusor reflex?

A

The reflex contraction of the detrusor muscle in order to expel urine

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19
Q

How is the detrusor reflex stimulated?

A
  • Increase in bladder pressure during filling
  • Detrusor stretched
  • Once at certain level of stretch = reflex contraction to urinate
  • Moderated in local reflex arc (no brain involvement)
  • Contraction occurs against urethral sphincter tone
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20
Q

What is the micturition reflex?

A

The reflex ejection of urine from the bladder, via the urethra
- Combination of detrusor reflex with inhibition of sympathetic, and voluntary motor supply to the bladder and urethra

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21
Q

Describe the micturition reflex

A
  • Voluntary or automatic
  • Detrusor contraction (stimulated by increased pressure)
  • Inhibits sympathetic and somatic supply to urethral sphincters
  • Bladder contracts, sphincters open, urine voided
  • Moderated at levels of sacral spinal and lumar spinal cord segments
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22
Q

What ensures complete voiding of the bladder?

A
  • Positive feedback to destrusor

- Will be completed once initiated

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23
Q

Describe the automatic control of micturition

A
  • Once bladder reaches particular pressure
  • No control of detrusor muscle, only control over external urethral sphincter
  • Reflex pathways, bladder empties spontaneously
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24
Q

Describe the voluntary control of micturition

A
  • Suppression of autonomic reflexes to a degree, but overridden once reaches certain pressure
  • Can initiate micturition at appropriate time
  • Increase intra-abdominal pressure to increase bladder pressure and initiate detrusor and micturition reflex
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25
Q

What drugs increase sphincter tone?

A

Alpha-sympathomimetic

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26
Q

What drugs decrease sphincter tone?

A
  • Alpha-adrenergic blockers

- Skeletal muscle relaxants

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27
Q

What drugs increase detrusor tone?

A

Parasympathomimetics

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28
Q

Define incontinence

A

Lak of voluntary control of excretory functions (can occur alongside normal micturition as is a lack of voluntary control, not dysfunction of micturition itself)

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29
Q

What do disorders of micturition refer to?

A
  • Abnormalities of detrusor or sphincters

- Normal, increased or decreased activity

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30
Q

List clinical syndromes of disroders of micturition

A
  • Inappropriate voidiig
  • Inadequate voiding with an overflow of urine
  • Increased frequency
  • Reduced capacity
  • Incomplete voiding
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31
Q

What is included in inappropriate voiding?

A
  • Dysuria
  • Stranguria
  • Pollakiuria
  • Nocturia
  • Enuresis
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32
Q

What is dysuria?

A

Difficult or painful passage of urine

33
Q

What is stranguria?

A

Straining or hesitancy associated with urination

34
Q

What is pollakiuria?

A

Increased frequency of urination (small volumes)

35
Q

What is nocturia?

A

The urge need to urinate overnight

36
Q

What is enuresis?

A

Unconscious leakage of urine during sleep

37
Q

What are the 2 general causes of incontinence?

A
  • Neurological

- Mechanical

38
Q

Why are neurological problems of incontinence more difficult to diagnose?

A
  • Lesion in sacral region may mean only have sympathetic supply
  • Or damage to lumbar region may remove sympathetic supply
39
Q

Describe the clinical presentation with respect to the bladder for animals with upper motor neurone dysfunction

A
  • Increased tone, retained reflexes (spastic paralysis)
  • Absence of voluntary micturition
  • Remove connection between brain and spinal cord
  • High volume of urine retention
  • Automatic bladder emptying possible
40
Q

Describe the clinical presentation with respect to the bladder for aniamsl with lower motor neurone dysfunction

A
  • Flaccid paralysis, areflexic
  • No perineal winking
  • Permanent leakage of urine as sphincters are open
  • Atonic bladder, easily expressed
  • Absence of voluntary micturition
  • Atonic urethral sphincters
  • Absent detrusor reflex
  • Concurrent reduced perineal reflex and anal tone
41
Q

List abnormalities of the bladder that can cause incontinence

A
  • Ectopic ureters
  • Acquired abnormalities of lower urinary tract (e.g. neoplasia, calculi, trauma)
  • Functional outflow obstruction (e.g. reflex dyssynergia)
  • Normal voiding with leakage (SMI)
  • Secondary detrusor muscle atony
  • Urge incontinence
  • Cat tail pull injuries
42
Q

Describe ectopic ureters as a cause of incontinence

A
  • Congenital maformation
  • Ureters entering directly into urethra
  • Most common of abnormalities
  • Constant dribble of urine
  • If one into urethra and one normal, can get constant dribble and normal urination
43
Q

Describe acquired abnormalities of the lower urinary tract as a cause of incontinence

A
  • Trauma e.g. fistula development (openign from urethra into inappropriate space) or scarring leading to strangulation of one of pathways
  • Blockage or malfomation of lower urinary tract system affects normal process of stage or voiding
44
Q

Describe functional outflow obstruction e.g. reflex dyssynergia as a cause of incontinence

A
  • Initiation of detrusor refex with reflex contraction of urethral sphincter
  • Goes through all motions of urination, but none voided (as sphincter is contracted)
  • Overfilling of bladder and risk of rupture
  • Can be internal or external sphincter contraction
45
Q

Describe sphincter mechanism incompetence as a cause of incontinence

A
  • SMI
  • Weak valve on bladder, leakage of urine
  • Normal micturition but continuous low level leakage or when increased abdominal pressure
  • More common in bitch
46
Q

Why is sphincter mechanism incompetence more common in the bitch?

A
  • Shorter effective length of urethra, less control
  • ## Spayed bitches (hormonal interactions)
47
Q

What are some treatment options for sphincter mechanism incompetence in the bitch?

A
  • Alpha-adrenergic agonists
  • Oestrogens
  • Surgery (culposuspension)
48
Q

Describe how secondary detrusor muscle atony can cause incontinence

A
  • Secondary to primary problem leading to detrusor muscle damage
  • Decreased/absent tone in detrusor, unable to contract and void urine
  • Over-stretchig usually cause
49
Q

Describe urge incontinence

A
  • Micturition reflex innitiated at low volume
  • More common with bladder mucosa irritation e.g. cystitis
  • Constant dribbling urine
50
Q

Explain how cat tail pull injuries can lead to incontinence

A
  • Avulsion of sacral nerves
  • Paralysis of S1, 2, 3 nerve functions
  • Permanent LMN paraysis of bladder, flaccid tail
  • Incontinent for life
51
Q

What are the important features of a clinical exam in micturition disorders?

A
  • History of voiding
  • Assessment of bladder size
  • Assessment of urethral sphincter tone
  • Assess integrity of detrusor/micturition reflex
  • Perineal reflex
  • Full neurological assessment may be needed
52
Q

How is bladder size assessed?

A
  • Palpation
  • Size (fullness) and tone
  • Should feel turgid, floppy = reduced detrusor/bladder tone
  • Important when suspect rupture
53
Q

How is urethral sphincter tone assessed?

A
  • Manual expression
  • Should not urinate on light squeezing
  • Urination would suggest loss of tone
54
Q

How is the integrity of the detrusor/micturition reflex assessed?

A
  • INcrease vesicular pressure (squeezing)
  • Should promote micturition at a particular pressure
  • Risk of rupture
55
Q

How is the perineal reflex assessed?

A
  • Lift tail and stimulate perineum
  • Look for anal winking
  • Same nerve stimulates this as does the sphincters (sacral segment)
56
Q

What are some renal pathological changes that may occur due to ectopic ureters?

A
  • Enlarged renal pelvic region
  • Enlarged kidney
  • Lost tone
  • Thickened ureter
  • Loss of architecture (distinction between layers)
  • Presence of blood due to inflammation
57
Q

Describe the normal defaecation and urination patterns of cows

A
  • Tail held in horizontal position, back rounded

- No preference for elimination sites

58
Q

Describe the normal defaecation and urination patterns of horses

A
  • Raise tail when urinate
  • Stretch legs out, stomach lowered to ground
  • Manure patterns influenced by gender
  • Stallions: sniff and defecate on top of manure pat
  • mares also siff, but do not turn before defaecating
  • Geldings less particular
59
Q

Describe the normal defaecation and urination patterns of dogs

A
  • Many normal postures
  • Females usually squat, males usually raise
  • Usually develop substrate and area preferences
60
Q

Describe the normal defaecation and urination patterns of cats

A
  • Back end lowered, straight back

- Strong substrate preferences and aversioins

61
Q

Describe the use of elimination in territorial marking in horses

A
  • Males urinate on eliminations of females
  • Specific stud piles
  • Mare likely to defaecate if sees another defaecating
  • Mare may sniff then urinate on dung pile if not seen produced
62
Q

Describe the use of elimination in territoral marking in dogs

A
  • Mark territory using urination
  • Pheromones in urine
  • Different to normal urine
  • More prominent in entire animlas
63
Q

Describe the use of elimination in territoral marking in cats

A
  • Urination rather than defaecation
  • Smaller volume, vertical surfaces, pungent smell
  • Multi-cat households
64
Q

Which species use elimination behaviour in reproductive signalling

A
  • Horses
  • Dogs
  • Cats
65
Q

Describe elimination behaviour for reproductive signalling in horses

A
  • Mares urinate more frequently
  • Urine with more mucus
  • Stand in squatting position
  • Clitoral winking
66
Q

Describe elimination behaviour for reproductive signalling in dogs

A
  • Frequent urination in prooestrus

- May get bloody vaginal discharge

67
Q

Describe elimination behaviour for reproductive signalling in cats

A
  • Frequent urination

- Production of clear vulval discharge

68
Q

Describe behaviour traits that facilitate house training in exotic species (meerkats, badgers, tiger quolls)

A
  • Communal toilets
  • Number of toilets near core territory
  • Some latrines on boundary shared by neighbouring groups
  • Provision of latrines that smell of different group encourages use of those toilets
69
Q

What stimulates elimination in puppies and kittens?

A
  • Unable to defaecate and urinate on their own
  • Stimulated by mother licking caudal abdomen and perineal regions
  • Stimualtes anogenital reflex = urination and defaecation
70
Q

Give a general idea of the development of elimination behaviour in puppies and kittens

A
  • Birth: unable alone, stimulated by mother
  • 15 days: voluntary elimination develops
  • 3-6 weeks: voluntary control acheived, follow mother to latrine site
  • 12 weeks: latrine preferences fixed
  • 6 months: leg cocking develops in males, onset of puberty
71
Q

What is the difference between spraying and latrine behaviour?

A
  • Spraying is to communicae

- Latrine behaviour is for elimination of urine or faeces

72
Q

What are the significant features of spray marking?

A
  • Usually in response to stress/high arousal
  • Significant areas of home
  • Still using appropriate latrine area for urine and faeces
  • Often vertical spraying posture with tail quiver
  • No evidence of physical ailment
73
Q

What may cause latrine behvaiour issues?

A
  • Medical disorders
  • Latrine aversion
  • Substrate preference/aversion
  • Location aversion/preference
  • Inadequate/loss of house training
  • Lack of indoor facility
74
Q

Give some situations that may result in house-soiling in cats

A
  • Inflammatory disease of urinary system/lower bowel
  • Conditions causing PUPD
  • Conditions causing cognitive decline
  • Historical associations with painful elimination
  • Introduction of new cat
  • Separation anxiety
75
Q

Give some medical causes of house soiling in dogs

A
  • Neoplastic (bladder tumours)
  • Metabolic disorders (diabetes)
  • Dietary
  • Pain related (hip dysplasia)
  • Infectious/inflammatory (urolithiasis)
  • Neurological
76
Q

Give some behavioural causes of house soiling in dogs

A
  • Lack/incomplete house training
  • Sexual signalling
  • Social signalling
  • Arousal
  • Owner related
  • Physical distress
  • Social distress
  • Secondary to psychogenic polydipsia
77
Q

How can house-soiling be modified using practical techniques?

A
  • Effective cleaning of soiled areas
  • Stop punishment
  • Chemical therapy to treat underying problem
  • Environmental manipulations (pheromones, control of stressor etc)
  • Control impact of stressor (prevent cat seeing other cats in area e.g. obscure window)
78
Q

Describe treatment for inappropriate latrine behaviour in cats

A
  • Ensure resources readily available for all cats
  • Protect area (L-shpaed litter box)
  • Confine for short periods if necessary
  • Stop punishment
  • Addess cause e.g. stress
  • Create attractive latrine areas
  • Retrain where necessary
79
Q

Describe treatment for house-soiling in dogs

A
  • House training
  • Do not punish
  • Reward appropriate behaviour
  • Learn cues from dog

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