Urinary Bladder, Microturition and Infections Flashcards

1
Q

what is the function of the bladder?

A

a temporary storage of urine that can empty at an appropriate time

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2
Q

where is the bladder situated when empty?

A

in the pelvic cavity

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3
Q

where is the bladder situated when full?

A

partly in the pelvic cavity but expands superiorly into the abdominal cavity

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4
Q

at what age does the bladder descend into the pelvis area from the abdominal area?

A

by the 5th or 6th age

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5
Q

what are the 4 parts of the urinary bladder?

A
  1. apex
  2. base
  3. superior surface
  4. inferolateral surface
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6
Q

what is the mucosal lining of the base of the bladder like?

A

smooth firmly attached to the wall

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7
Q

what is the mucosal lining of the base of the bladder attached to?

A

the underlying smooth muscle coat of the wall

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8
Q

what is the mucosal lining of the bladder like elsewhere besides the base?

A

folded and loosely attached to the wall

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9
Q

what is the trigone?

A

he smooth triangular area between the openings of the ureters and urethra on the inside of the bladder

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10
Q

what is the main difference between a male and female’s bladder and urethra?

A

males have an internal and external urethral sphincter but females only have an external one.

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11
Q

what does the sympathetic nerve do to the bladder?

A

transmit impulses from the pain receptors to the upper lumbar segment resulting in the perception of pain sensation from the urethra & bladder.

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12
Q

what does the pelvic (parasympathetic) nerve do to the bladder?

A

transmit impulses from the tension and pain receptors present in the wall of the bladder to the sacral region of spinal cord resulting in both reflex micturition & sensation of bladder fullness

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13
Q

what does the pudendal (somatic) nerve do to the bladder?

A
transmit impulses for the sensation of:
 Distention of the urethra.
 Passage of urine through
the urethra.
 Maintains the tonic contractions of the skeletal muscle fibers of the external sphincter.
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14
Q

how does the pelvic nerve work?

A

releases ACh at the M3 receptor on the bladder to cause muscle contraction to force the urine out

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15
Q

how does the sympathetic nerve work?

A

releases noradrenaline at the bladder beta receptor and urethra alpha receptor to:
1. inhibit contraction of the bladder
2. stimulate contraction of the urethra.
Both to prevent urine release

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16
Q

How does the pudendal (somatic) nerve work?

A

releases ACh at the nicotinic receptors of the external urethral sphincter to cause contraction hence preventing urine release

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17
Q

what fibres supply the sympathetic system in the bladder?

A

The preganglionic fibres which branch from the upper 4 lumbar vertebrate.
The postganglionic fibres arise from the hypogastric ganglia

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18
Q

what are the functions of the sympathetic nerves?

A

 Inhibitory to the bladder wall (detrusor muscle).
 Motor to the internal urethral sphincter.
 Motor to the seminal vesicle, ejaculatory duct & prostatic musculature. It prevents the reflux of semen into the bladder.

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19
Q

what is the wall of the bladder called?

A

the detrusor wall

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20
Q

what fibres supply the parasympathetic system in the bladder?

A

the preganglionic fibres from the 2nd, 3rd and 4th sacral segments the vertebrate

21
Q

what are the functions of the parasympathetic nerves?

A

 Motor to the bladder wall (detrusor muscle).

 Inhibitory to the internal urethral sphincter.

22
Q

what fibres supply the somatic system in the bladder?

A

-they arise from the 2nd, 3rd and 4th sacral segments and supplies the external urethral sphincter

23
Q

what is the function of the somatic supply?

A

 Motor to the external uretheral sphincter.

24
Q

when does the micturition reflex start to appear??

A

from stage 1 when the bladder reaches 150-300ml. So the early stage of feeling the urge to urinate

25
Q

at what point can micturition no longer be suppressed?

A

at about 700ml (break point)

26
Q

what is the storage phase of micturition?

A

the filling phase

27
Q

what is the voiding phase of micturition?

A

the emptying phase

28
Q

what helps to empty the female urethra?

A

gravity

29
Q

how is urine in the urethra of the male expelled?

A

by several contractions of the bulbocavernosus muscle.

30
Q

what part of the brain receives and coordinates the detrusor afferent stimuli?

A

The parietal lobes and thalamus

31
Q

what part of the brain provides modulation with inhibitory signals?

A

the frontal lobes and basal ganglia

32
Q

where does central coordination occur?

A

in the pontine micturition centre

33
Q

The cortical centres facilitate micturition by discharging signals which leads to what?

A

 Stimulation of sacral micturition center.
 Inhibition of pudendal nerves which causes relaxation of external urethral sphincter.
 Contraction of anterior abdominal muscle & diaphragm to increase intra-abdominal pressure. This intensifies the micturition reflex.
 Voiding under parasympathetic regulation (pelvic nerve)

34
Q

The higher centres inhibit micturition by what?

A

 Inhibition of sacral micturition center.
 Stimulation of pudendal nerves ⇒ contraction of external urethral sphincter.
 Holding of urine under sympathetic regulation (hypogastric nerve)

35
Q

what is a cystometrogram?

A

a graph of the pressure applied on the bladder against the volume of urine in the bladder

36
Q

What are the 3 types of incontinence?

A
  1. overflow
  2. stress
  3. urge
37
Q

what is overflow?

A

blockage of the urethra so the bladder can’t empty properly

38
Q

what is stress?

A

when the pelvic floor is relaxed causing increased abdominal pressure

39
Q

what is urge?

A

when the bladder is oversensitive due to an infection that causes neurological disorders.

40
Q

what is atonic (hypotonic) bladder?

A
  • when the sensory nerve fibers from the bladder are destroyed e.g. by a disease, injury
  • causes the person to loose bladder control as the bladder muscle looses the tone and becomes flaccid so urine overflows and drips through the urethra.
41
Q

how to treat atonic bladder?

A
  • Bladder catheterization and correction of the underlying causes
  • Neurogenic problems treated with anticholinesterases to increase detrusor contraction.
42
Q

what type of drugs make atonic bladder worse?

A

antimuscarinics

43
Q

what is Spastic neurogenic (automatic) bladder?

A
  • During spinal shock after complete transection of spinal cord above sacral centres of micturition, the urinary bladder looses its tone and becomes flaccid and unresponsive causing overflow.
  • spinal shock due to sudden separation of the spinal centres from the higher centres that control them
  • when bladder is filled with some amount of urine, there is automatic evacuation of the bladder
44
Q

what is uninhibited neurogenic bladder?

A
  • a lesion in some parts of the brain stem interprets inhibitory signals so we get continuous excitation of spinal micturition centres by the higher centres.
  • micturition is now uncontrolled increasing need to urinate
45
Q

what is Nocturnal micturition?

A

AKA bed wetting:

  • common in infants and kind <3yrs old
  • occurs due to incomplete myelination of motor nerve fibers of the bladder resulting loss of voluntary control of micturition
46
Q

what is Overactive bladder syndrome?

A

when the detrusor produces uncontrolled bladder contractions during normal filling.

  • can be associated with a stroke, spinal injury, MS
  • can also be secondary to the meds already taking
  • causes urinary urgency and frequency, nocturia
47
Q

what is urethral sphincter incompetence?

A
  • Dribbling and/or continuous leakage associated with incomplete bladder emptying, due to impaired detrusor contractility and/or bladder outlet obstruction.
  • Urethral sphincter incompetence produces stress incontinence in women (urine leakage with effort, exertion, coughing etc.) or sphincter weakness incontinence in men.
48
Q

what is Painful bladder syndrome/interstitial cystitis (PBS/IC)?

A
  • urothelial abnormalities alter bladder epithelial expression of HLA Class I and II antigens
  • so the bladder sensory neurones are activated during normal bladder filling