217- neurology and voiding dysfxn

Question 1

Sympathetic innervation of bladder:

parasympathetic innervation of bladder:

Somatic innervation of External urethral sphincter

Answer 1

arises T10-L2 and travels via hypogastric. In addition to alpha and beta receptors, also inhibits parasympathetics

Arises from S2-S4 and travel via pelvic

Arises from S2-S3 and travel via pudendal. nerve bodies on Onuf’s nucleus. Nicotinic receptors

Question 2

Coordination center for micturition

Answer 2

Pontine micturition center. (barrington’s nucleus)

Question 3

first neurologic change with voiding of bladder

Answer 3

relaxation of EUS then detrusor contraction which pulls open bladder neck

Question 4

What happens when you have a neurologic lesion above the pons? are you worried about kidneys? Examples?

Answer 4

Loss of inhibition from cortex with intact coordination so no danger to kidneys because no increase in storage pressure. Stroke, alzheimers, tumor.

Question 5

what happens in lesions below pons in supra sacral region? how do you diagnose? Can it damage kidneys? Treatment?

Answer 5

loss of coordination. Bladder urodynamic study. Can get bladder hyper reflexia and bladder-detrusor dyssynergia. Can damage kidneys. Treat with meds (anti-cholinergics, beta agonists), botox, surgical enlargement

Question 6

lesion in sacral spinal cord effect? Can it damage kidneys? Treatment?

Answer 6

atonic bladder, inability to void volitionally. Won’t usually damage kidneys. Treat with catheter

Question 7

cholinergic receptors: what releases ACh? What are the types of receptors and where are they?

Answer 7

Released from: all preganglionic autonomics, postganglionic parasympathetics, somatic neurons

Muscarinic Receptors: on all autonomic effector cells (bladder, sweat glands, bowel, CNS).

Nicotinic Receptors: on skeletal muscle endplates, in autonomic ganglia

Question 8

what type of cholinergic receptors are there on the bladder?

Answer 8

muscarinic: M3 (20%) responsible for muscle contraction

M2 (80%) enhance response to M3 by inhibiting sympathetic suppression of detrusor contraction

Question 9

initial effect of spinal cord injury

Answer 9

shock. May last for days- weeks. usually areflexia resulting in urinary retention so you catheterize