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Renal Exam 1 > Micturition > Flashcards

Micturition Flashcards

1
Q

Upper urinary tract

-components?

A

Calyces, pelvis, ureters

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2
Q

Bladder

-Function?

A
  • Stores urine under low pressure

- Expels urine under high pressure

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3
Q

Urethra

  • What is it?
  • Function?
A
  • A conduit for carrying urine from the body

- Its two sphincters control voiding

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4
Q

Urinary bladder and sphincters

-2 sphincters?

A
  • Internal

- External

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5
Q

Urinary bladder

  • Internal sphincter
    • Type of control?
    • Type of muscle?
    • Where is it?
A
  • Involuntary control
  • Smooth muscle
  • It is the wall of the bladder as it narrows toward the urethra
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6
Q

Urinary bladder

  • External sphincter
    • Type of control?
    • Type of muscle?
    • Where is it?
A
  • Voluntary control
  • Skeletal muscle
  • Wraps around exterior of urethra where it joins bladder
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7
Q

Urinary bladder

-External sphincter-associated nerve?

A

Pudendal nerve

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8
Q

Urinary bladder

-Internal sphincter-associated nerve?

A

Pelvic nerve

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9
Q

Hypogastric nerve-slide 6?

A

?

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10
Q

Local Nervous Control

  • Innervation of the urinary tract-afferent pathways for conscious bladder sensations
    • Through which nerve or plexus?
A
  • Through pelvic splanchnic nerve or hypogastric plexus

- S2-S4

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11
Q

Local Nervous Control

  • Innervation of the urinary tract-afferent pathways for conscious bladder sensations
    - Posterior columns?
A

Bladder fullness

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12
Q

Local Nervous Control

  • Innervation of the urinary tract-afferent pathways for conscious bladder sensations
    - Anterolateral columns?
A

Bladder pain

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13
Q

Reflex arc for the micturition reflex-sacral micturition center
-From bladder?

A

Bladder–>sacral detrusor nucleus–>Bladder?

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14
Q

Reflex arc for the micturition reflex-sacral micturition center
-From urethra?

A

Urethra–>sacral micturition center–>voluntary sphincter

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15
Q

Efferent nervous controls of the bladder and urethra

  • Sensory fibers
    • From?
    • Activated by?
A
  • From bladder wall, posterior urethra

- Activated by stretch

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16
Q

Parasympathetic fibers

  • Neurotransmitter?
  • Nerve?
  • Functions?
A
  • Cholinergic-acetylcholine
  • From sacral micturition center S2-S4 (pelvic nerve)
  • Stimulate detrusor muscle
  • Inhibit contraction of internal urethral sphincter
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17
Q

Sympathetic fibers

  • Neurotransmitter?
  • Nerve?
  • Functions?
A
  • Neurotransmitter-adrenergic-NE
  • Hypogastric nerve
  • Inhibits detrusor constriction
  • Constricts internal urethral sphincter
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18
Q

Somatic motor neurons

  • Type of control?
  • Nerve?
  • Function?
A
  • Voluntary control
  • Pudendal nerve
  • Constrict external urethral sphincter
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19
Q

Overview of bladder and urethra?

A

Slide 12

20
Q

Central control of micturition-The micturition reflex

  • Where is it located?
  • What is it called?
A
  • Pontine micturition center (Barrington’s center)

- Locus ceruleus of the pons

21
Q

Central control of micturition

  • Descending impulses control?
  • Coordinates?
A
  • Descending impulses control sacral micturition center and thoracolumbar sympathetic outflow
  • Coordinates activity of bladder and urinary sphincters
22
Q

Autonomic modification of ureter peristalsis

-Ureters are supplied with?

A

-Ureters are supplied with parasympathetic and sympathetic fibers

23
Q

Autonomic modification of peristalsis

  • Ureters are supplied with parasympathetic and sympathetic fibers
    • Parasympathetic stimulation function?
    • Sympathetic stimulation function?
A
  • Parasympathetic stimulation increases frequency of peristaltic contractions in ureter, increasing urine delivery to bladder
  • Sympathetic stimulation does the opposite
24
Q

Stress-relaxation of the bladder minimizes pressure rise as the bladder fills
-graph on slide 18

A

Changes in intravesical pressure as the bladder fills with urine

25
Q

The micturition reflex

  • Early bladder filling-As radius increases, wall tension increases
    • Equation?
A

T = (P x r)/2

26
Q

The micturition reflex

- Early bladder filling
     - Which receptors are activated? What do they do?
A
  • Bladder stretch receptors are activated, send sensory information to:
    • Sacral micturition center
    • Higher centers in brainstem, cerebral cortex
27
Q

The micturition reflex

  • Early bladder filling
    • Bladder stretch receptors are activated, send sensory information to: Sacral micturition center-function?
A

Activates parasympathetics

28
Q

The micturition reflex

  • Early bladder filling
    • Bladder stretch receptors are activated, send sensory information to: Higher centers in brainstem, cerebral cortex-function?
A

Suppress parasympathetic impulses

29
Q

The micturition reflex

  • Later bladder filling
    • Increasing?
    • Inhibition of?
A
  • Increasing wall tension, more frequent sensory impulses from stretch receptors
  • Inhibition of sacral micturition center by higher centers in brain in overridden
30
Q

The micturition reflex

  • Later bladder filling
    • Parasympathetic impulses from?
      • Function?
A

Parasympathetic impulses from sacral cord:

  • Stimulate bladder contraction
  • Inhibit contraction of internal urethral sphincter
31
Q

The micturition reflex

  • Later bladder filling
    • Urine enters?
A

Posterior urethra

32
Q

After urine enters urethra?

A
  • Sensory impulses from urethra to sacral cord inhibit somatic nerves that constrict external sphincter
  • Bladder continues to fill, contractions intensify
  • Sensory impulses from bladder and urethra become more powerful
  • When the time is right, external sphincter relaxes, urine is voided
33
Q

Bladder empties passively

-What happens to tension of bladder wall?

A
  • Tension of bladder wall declines as urine is voided (T = (P x r)/2
  • Decreased radius maintains intravesical pressure despite increased tension
  • Enables bladder to empty its residual volume
34
Q

Slide 24-summary of micturition

A

….

35
Q

Abnormalities of micturition (neuropathic bladders)

  • Results from damage to neural elements controlling micturition
  • Four basic types
A
  • Atonic bladder
  • Denervated bladder
  • Automatic bladder
  • Uninhibited neurogenic bladder
36
Q

Atonic (flaccid neuropathic) bladder

-Cause?

A

Destruction of sensory inputs from bladder to sacral cord (diabetes, crush injury, syphilis, MS)

37
Q

Atonic (flaccid neuropathic) bladder

-Pathology?

A
  • Stretch information no longer transmitted
  • Bladder contractions are no longer initiated
  • Bladder becomes flaccid and filled to capacity-“Overflow incontinence”;eventually distended, thin-walled
38
Q

Denervated (hypertrophic areflexic) bladder

-cause?

A

Destruction of both afferent and efferent fibers between bladder and cord

39
Q

Denervated (hypertrophic areflexic) bladder

-Initial pathology?

A
  • Detrusor contractions cease

- Bladder becomes flaccid, distended

40
Q

Denervated (hypertrophic areflexic) bladder

-Later pathology?

A
  • Detrusor regains spontaneous activity
  • Bladder shrinks
  • Muscle wall hypertrophies
41
Q

Automatic (spastic neuropathic) bladder

-Cause?

A

-Injury or severing of spinal cord above sacral region: cuts off communication with brain

42
Q

Automatic (spastic neuropathic) bladder

  • Acute phase?
  • Long term?
A
  • ‘spinal shock’ temporarily suppresses micturition reflex–>flaccid neuropathic bladder
  • Long term-micturition reflex can gradually recover and become exaggerated resulting in spasticity-control by brain is lost
43
Q

Uninhibited neurogenic bladder (autonomic dysreflexia)

-Cause?

A

-Destruction of tracts carrying inhibitory impulses from brain

44
Q

Uninhibited neurogenic bladder (autonomic dysreflexia)

-Pathology?

A
  • Facilitatory inputs remain intact
  • Micturition center is continually stimulated
  • Micturition is activated by small amounts of urine
  • Detrusor hypertrophies, bladder capacity reduced
45
Q

Urinary tract infections

-How are they related to the bladder and urethra?

A
  • Bladder and urethral irritation from the infection
  • Uninhibited contraction of detrusor muscle with facilitation of the micturition reflex
  • Leads to urinary frequency and leakage
46
Q

3 anatomical divisions of the urinary tract?

A
  • Upper urinary tract
  • Bladder
  • Urethra

Renal Exam 1 (6 decks)

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