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Semester 4 > case 8 - pbl > Flashcards

case 8 - pbl Flashcards

1
Q

what are the two main parts of the smooth muscle bladder chamber

A

the body
the neck

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2
Q

what happens in the body

A

this is where the urine collects

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3
Q

what are features of the neck

A

funnel shaped and connects with the urethra

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4
Q

what is the smooth muscle of the bladder called

A

the detrusor muscle

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5
Q

what is on the posterior wall of the bladder

A

the trigone

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6
Q

what is the trigone mucosa like

A

mucosa of this is smooth and is folded into rugae

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7
Q

where do the two ureters enter the bladder

A

at the uppermost angles of the trigone

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8
Q

name features of the internal sphincter

A

smooth muscle
involuntary control
parasympathetic

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9
Q

name features of the external sphincter

A

skeletal muscle
voluntary muscle
somatic innervation

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10
Q

what is normal urine flow

A

20-50mls

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11
Q

what is the layout of the urinary tract

A

the kidneys produce urine, the ureters connect the kidney to the bladder, where urine is stored and the urethra is the exit passage way from the bladder

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12
Q

what is the prostate

A

a compound tubuloalveolar exocrine gland

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13
Q

what does the prostate secrete

A

a slightly alkaline fluid that constitutes 30% of the semen volume

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14
Q

what does the prostate help to do

A

neutralise the acidity of the vaginal tract and prolongs the lifespan of the sperm

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15
Q

what are the four zones of the prostate

A

Transition zone
Peripheral zone - 70% of the gland
Central zone
Fibromuscular zone

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16
Q

what happens during ejaculation

A

during ejaculation, sperm is transmitted from the ductus deferent into the make urethra via ejaculatory ducts, which lie within the prostate gland

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17
Q

what is PSA excreted from

A

the prostaste

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18
Q

what converts testosterone to DHT

A

type 5 alpha - reductase

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19
Q

what does DHT cause

A

cell growth and inhibits apoptosis

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20
Q

is testosterone or DHT more potent

A

DHT

21
Q

what are the two main steps of mictruition

A

The bladder fills until the tension in its walls rises above the threshold level

Elicits a nervous reflex - mictrurition reflex that empties the bladder

22
Q

where does the urine flow from after the collecting ducts

A

the renal calyces, thus stretching them

23
Q

what does the stretching of these calyces do

A

This increases pacemaker activity, which in turn initiates peristaltic contractions that spread to the renal pelvis and then downward along the length of the ureter. This forces urine from the renal pelvis to the bladder

24
Q

what are peristaltic contractions of the ureter enhanced by

A

Peristaltic contractions in the ureter are enhanced by parasympathetic stimulation and inhibited by sympathetic stimulation

25
Q

what is the name of the reflux when the contraction of the bladder does not lead to complete occulsion of the ureter

A
  • urine is propelled backward into the ureter - vesicoureteral reflux
26
Q

what does this cause

A

renal dysfunction

27
Q

explain and describe the micturition reflex

A

as the bladder fills, sensory stretch receptors in the wall, initiate a stretch reflex
Sensory signals are conducted to the scarab plexus through sensory afferents of the pelvic splanchnic nerves and then reflexively back to the baller through the motor efferent fibres of the same splanchnic nerves
When bladder is only partially filled, the contractions usually relax and pressure falls to baseline
As it continues to fill, reflexes become more frequent and cause greater contractions of the detrusor muscle
This reflex is self-regenerative
Causes another reflex to pass through the pudendal nerves to the external sphincter to inhibit it

28
Q

what happens in BPH

A

the small glands, muscle fibres and connective tissue all enlarge

29
Q

what is the first change seen in BPH

A

the proliferation of the glandular tissue in the transitional zone

30
Q

what is an important factor in causing BPH

A

the impairment of apoptosis

31
Q

what happens when epithelial cells multiply excessively

A

they release an excessive amount of PSA into circulation

32
Q

what is BPH mainly due to

A

impairment of apoptosis

33
Q

what does this result in

A

accumulation of senescent cells in the prostate

34
Q

what can androgens such as DHT do

A

can not only increase proliferation but inhibit cell death

35
Q

what cells are responsible for androgen-dependent prostatic growth and why

A

Stromal cells are responsible for androgen-dependent prostatic growth because the type 2 5alpha reductase enzyme is only found in the stromal cells

36
Q

what is hydronephrosis

A

is the dilation of the renal pelvis associated with progressive atrophy in the kidney due to obstruction to the outflow of urine

37
Q

describe the pathology of prostate cancer

A

growth and multiplication of cells escape from normal control
Impairment of apoptosis due to mutation of p53
Occurs in the peripheral zone of the prostate
Invades stroma

38
Q

what is the epidemiology of prostate cancer

A

prostatic carcinoma accounts for 7% of cancer in men
6th most common in the world

39
Q

histologically, what kind of cancer is prostate cancer

A

adenocarcinoma

40
Q

what is the gene associated with prostate cancer

A

BRCA I and II

41
Q

what are the features of PSA testing

A

Interpreted with caution as natural increase in age and with prostatitis
Dilemma about screening methods as can lead to over-diagnosing patients who don’t require treatment

42
Q

what is the mechanism of action of tamsulosin

A

Competitive inhibition for binding site of the alpha1 adrenergic receptors
Causes prostate smooth muscle relaxation
Reduces urethral occlusion
Quick acting
May cause a sudden drop in BP - dizziness

43
Q

what is the mechanism of action of finasteride

A

blocks the enzyme 5 alpha reductase type 2
Slows conversion of testosterone to DHT - slowing down growth of stromal and epithelial cells
Promotes apoptosis
Slow acting

44
Q

what is transurethral resection of the prostate

A
  • gold standard in reducing symptoms, improving flow rates and decreasing post-voiding residual urine
    Removes parts or all of the prostate
    Loss of ability to ejaculate
45
Q

what is inclusion health

A

Inclusion health is an umbrella term used to describe people who are socially excluded, who typically experience multiple overlapping risk factors for poor health, such as poverty, violence and complex trauma.

46
Q

what services on the NHS are available to asylum seekers

A

In Scotland and Wales they are entitled to free secondary health care
In England they are only offered free secondary health care if they receive section 4;2 support from the home office

47
Q

when can asylum seekers begin to work

A

People who have claimed asylum in the UK can apply for permission to work if they have been waiting 12 months for a decision, and they are not considered responsible for the delay. If permission is granted, the person will be allowed to take up jobs on the shortage occupation list only.

48
Q

what is PSA required for

A

liquefying the semen

Semester 4 (80 decks)

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