Brainscape's Knowledge GenomeTM

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


See full index

FERGU > Week 4- Bladder Obstruction > Flashcards

Week 4- Bladder Obstruction Flashcards

1
Q

What is the innervation of the kidneys, ureters, bladder and urethra?

A

Kidney:

  • T10-L1 (SNS)
  • vagus (PNS)
  • Only SNS feels pain?

Ureter

  • T11-L2 (SNS)
  • S2,3,4 (PNS)
  • Both can feel pain

Bladder

  • Same as ureter, BUT PNS has the pain fibers

Urethra

  • L1,2 (SNS)
  • S2,3,4 (PNS)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Trace the path of a sympathetic neuron going to the bladder. What does it innervate?

A

Pre-ganglionic neuron comes out of the spinal cord at T11-L2, goes through the white rami communicans an to a pre-aortic ganglion. Then intermesenteric plexus, then superrior hypogastric plexus, which bifurcates. And then goes to innervate the:

  • detrusor (B-adrenergic= relax)
  • internal sphincter (alpha-adrenergic= contract)
  • seminal vesicles (ejaculate)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Trace the path of a parasympathetic neurons going to the bladder. What does it innervate?

A

Preganglionic comes out of S2,3,4, synapses in the hypogastric plexus. Innervates:

  • detrusor (msucarinic ACh= contract)
  • internal spincter (=relax)
  • penis (erection)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Trace the path of a sympathetic nerve going to the kidney

A

The pre-ganglionic nerve comes out of T10-L1, goes through the white ramus communicans, then synapses in the renal ganglion and continues on to the kidney.

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

Trace the path of a parasympathetic nerve going to the kidney

A

The vagus nerve (cranial nerve X) goes there….

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

What is LUTS?

A

Lower Urinary Tract Symptoms. A constellation of symptoms from either obstructive or irritative voiding disturbances.

  • Urinary frequency
  • Nocturia
  • Urgency, with or without incontinence
  • Hesitancy in initiating the stream
  • Weak stream
  • Dysuria
  • Sense of incomplete bladder emptying
  • Post void or terminal dribbling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What the the differential for LUTS?

A

Huge!

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

What to ask your patient with LUTS?

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

What are irritative vs. obstructive voiding dysfunction symptoms?

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

Are dysuria, microhematuria and incontinence normally seen in BPH?

A

Not in uncomplicated cases

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

What is IPSS?

A

International prostate symptom score

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

What would you always do with a man with prostate enlargement? What would you sometimes do?

A

Always:

  • IPSS
  • Urinanalysis

Sometimes:

  • PSA
  • Serum creatinine (if suspected hydronephrosis)
  • cytology (if predominantly irritative symptoms)
  • urodynamic studies (e.g. post-void residual volume)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are BOO, BPE and BPH?

A

BOO: bladder outlet obstruction (a clinical term)

BPE: benign prostate enlargement (a clinical term)

BPH: benign prostate hyperplasia (a histological diagnosis)

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

Does BPH progress? What are predictors of progression?

A

Yes- in some patients- the prostate continues to enlarge. Age, prostate volume and PSA levels are all negative. Symptoms can worsen, or acute urine retention

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

What is the treatment algorithm for BPH? (see other slides for the rationale of each treatment)

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

What are lifestyle measures for treating BPH?

A

“sleep apnea” means treating sleep apnea because it can cause nocturia.

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

Are the alpha-adrenergic blockers used for BPH selective or non-selective for urinary tissue? What are side-effects

A

They are selective. Older drugs were not selective.

Tamulosin (Flowmax) can produce retrograde ejaculation (not a problem except for fertility), but not erectile dysfunction

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

Is viagra (PDE5i’s) safe with non-selective alpha blockers? Selective alpha blockers?

A

Can result in hypotension with non-selective , but is safe with selective alpha blockers

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

How is cell growth promoted in the prostate? (e.g. what hormone, and how is this targeted)

A

Testosterone: converted to its more powerful self, DHT intracellularly by either Type 1 or Type 2 5-alpha-reductase. Type 2 is found only in the prostae, type 1 is found in the skin, liver, bladder.

Can block Type 2 (finasteride)

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

What are the important side effects of type 2 5-alpha reductase inhibitors?

What is the great thing about them?

A

Sexual side effects (ED….)

They reduce the risk of prostate cancer by 25%

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

How to treat: low IPSS, large prostate and PSA?

A

With a 5ARi alone. Don’t need in combination with an alpha-blocker because the alpha-blocker deals mostly with the symptoms

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

How to treat: low IPSS, small prostate and low PSA.

A

No treatment.

23
Q

How to treat: high IPSS, bother, small prostate, low PSA

A

An alpha blocker to treat symptoms. They won’t benefit from shrinking the prostate

24
Q

How to treat: high IPSS, bother, large prostate, high PSA level

A

WIth combination therapy. 5ARi shrinks the prostate, and the 5 alpha blocker helps with symptoms

25
Q

What are absolute indications for prostate surgery in someone with BPH?

A

Urinary retention

Renal failure

26
Q

What is the main surgery performed for BPH?

A

TURP (TUPR)

Scrapes away the transition zone of the prostate

27
Q

If you’ve had one TURP, will you need another?

A

Maybe. About 10% do within 10 years.

28
Q

What are the chronic complications of BPH?

A
  • Decreased QoL
  • worsening of LUTS
  • acute urinary retention
  • recurrent UTI
  • stones
  • renal failure
29
Q

Why do men with BPH have voiding symptoms?

A

Men with BPH have a bladder outflow obstruction. This leads to obstructive symptoms (hesitancy, dribbling/reduced caliber) and bladder hypertrophy. Bladder hypertrophy leads to irritability of the detrusor and this leads to irritative bladder symptoms (urgency, frequency, nocturia

30
Q

Why isn’t PSA used as a universal screening tool for prostate cancer? What are the limitations of PSA measurements?

A
  • It has a high sensitivity but a low specificity
  • results in overdiagnosis and treatment
  • many prostate cancers progress slowly

It is used in those with high risk of prostate cancer (including age) and who do not have significant comorbidities and who have a life expectancy >10 yrs

limitations: there are reasons besides cancer that the PSA could be elevated.

31
Q

What are the parts of the bladder (x2) and the outlet (x2)

A

Bladder=detrusor + trigone

Outlet= bladder neck + urethra

32
Q

What feature of the bladder allows for urine storage? What nerves/receptors meadiate this?

A

A relaxed detrusor has a high compliance, allowing the bladder to store urine at low pressure.

Bladder relaxation: sympathetic B3 receptor, direct CNS inhibition of detrusor motor neurons.

Outlet contraction: sympathetic alpha receptor

33
Q

What is the voiding reflex?

A

Distention of the bladder –> activation of PNS afferents –> sacral spinal –> activation of PNS efferents (muscarinic) contracts detrusor, inhibits sympathetic (detrusor and internal sphincter) and pudendal (external spincter)

34
Q

How is the bladder outlet controlled when we want to store urine?

A
  • SNS (alpha) contracts internal sphinter
  • Pressure from urine building up causes pudendal nerve to clamp the external sphincter down and create a mucosal seal
35
Q

Where does the CNS control of voiding come from?

A

The pontine micturition centre (PMC)…receives input from the cortex

36
Q

What is the basic classification of urinary incontinence?

A

Failure to store OR failure to empty caused by

A problem with the bladder OR a problem with the outlet

37
Q

Briefly define types of urinary incontinence:

  • stress incontinence
  • urge incontinence
  • overflow (incomplete emptying)
  • total
  • functional
A

Stress UI: leakage when laughing, coughing, change in position etc.. seen in young women

Urge: incontinence preceded by urgency. detrusor overacitivty

Overflow: incomplete emptying (bladder outlet obstruction until proven otherwise)

Total: leaking all the time. fistula between bladder and something

Functional: inability to get to a toilet (usually mobility issues)

38
Q

Causes of transient reversible urinary incontinence

A

DIAPERS

Delirium

Infection

Atrophic vaginitis/urethritis

Pharmacologic

Excess urine output

Restricted mobility

Stool impaction

39
Q

What are the indications for anticholinergics in the treatment of urinary incontinence? S/E?

A

Overactive bladder/urge incontinence. Anticholinergics would reduce PNS mediated detrusor muscle spasm.

Oxybutinin (Ditropan) is the only one covered in BC

Side effects:

  • dry mouth
  • dry eyes
  • blurred vision
  • constipation
  • flushing
  • confusion
40
Q

What are the risk factors for prostate cancer?

A

Age

FHx (especially a 1st degree relative)

African- American

Previous abnormal biopsy

41
Q

When does prostate cancer cause symptoms?

A

When it is advanced or metastatic

42
Q

When is PSA elevated?

A
  • prostate cancer
  • increased size of prostate (BPH)
  • post-instrumentation
  • following DRE
  • inflammation (prostatitis)
43
Q

What is the differential of a prostatic nodule?

A
44
Q

What are the limitations in using DRE for the detection of prostate cancer?

A

~15% of cancers do not arise peripherally (where they can be palpated)

there are otehr causes for nodules besides cancer

…best used in combination with PSA

45
Q

What is the diagnostic approach to prostate cancer?

A

DRE, PSA (abnormally high, or rising quickly) –> transrectal US biopsy

46
Q

After diagnosis, how is prostate cancer graded and staged and how is risk of progression assesed?

A

Grading:

  • Because prostate cancer is heterogeneous, you give the 2 most common groups of cancerous cells a grade out of 5 each, and then you combine the grades into the Gleason Score

Staging:

  • TNM

Risk of Progression is based on tumour grade, stage, PSA and determines future treatment

47
Q

Is prostate cancer unifocal/multifocal and homegenous/heterogeneous?

A

It is almost always multifocal and heterogenous (can have several different tumours). This is why the entire prostate is removed.

48
Q

What are treatment options for localized prostate cancer?

A

Radical prostatectomy

  • retropubic
  • perineal
  • laproscopic, robotic

Radiation

  • external beam
  • brachytherapy

Active surveillance

  • only appropriate for low risk, compliant, low-anxiety patients.
  • periodic DRE, PSA and biopsies
49
Q

What are the big complications of surgical treatment of prostate cancer?

A
  • bleeding (the prostate is highly vascular)
  • erectile dysfunction, no ejaculation (orgasm and genital sensation should not be affected)
  • urinary incontinence (10%, stress incontinence)
50
Q

What are the big complications of radiation therapy for prostate cancer?

A
  • damage to pelvic nerves leading to ED
  • incontinence
  • late secondary malignancies
51
Q

What are the treatment options for locally advanced or metastatic prostate cancer?

A

Standard care is hormone therapy.

If refractory to hormone therpay, can use chemo (docetaxel)

52
Q

What is the endocrine axis for testorone?

A

lack of androgen receptor stimulation in HT–> LHRH (GnRH) secretion from HT–> stimulation of pituitary to release LH–>LH binds in testes, causes testosterone production–> testosterone binds androgen receptor in HT and turns off LHRH

53
Q

How could DM cause overflow incontinence?

A

Damage to peripheral nerve endings

FERGU (7 decks)

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