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Pathophysiology > Class 5 chapter 27 > Flashcards

Class 5 chapter 27 Flashcards

1
Q

Micturition Reflex

A

Begins when bladder contains 150-250 mL of urine

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2
Q

Spastic Bladder

A

Failure to store

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3
Q

Spastic Bladder causes

A

Spinal cord injury, herniated interverterbral disc, vascular lesions, myelitis (inflammation of the spinal cord)

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4
Q

Spastic Bladder manifestations

A

Reflex bladder spasms cause emptying when not full (muscle shrinks)
Overflow dribbling, frequency, nocturia, urgency.

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5
Q

Flaccid Bladder

A

Failure to empty

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6
Q

Flaccid Bladder causes

A

Injury to spinal cord or nerves supplying bladder = destrusor muscle areflexia
Lesions of external sphincter result in non-relaxation
Surgery (anaesthetic), inflammation/irritation

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7
Q

Flaccid Bladder manifestations

A

Dribbling, retention

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8
Q

What methods can be used to determine if a patient has a flaccid bladder?

A

Post void residual (PVR)
Bladder scan
Catheterization (in and out)
Ultrasound

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9
Q

Neurogenic Bladder Treatment

A
  1. Catheterization
  2. Bladder training
    Spastic - tap suprapubic or genitals
    Flaccid - suprapubic pressure
  3. Pharmacology
    Spastic - to decrease detrusor muscle tone
    Flaccid - to increase detrusor muscle tone and/or decrease muscle tone of external sphincter
  4. Surgery
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10
Q

Urinary Incontinence: Types/Causes

A
  1. Stress

2. Overactive bladder/urge incontinence

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11
Q

Stress incontinence

A

Weak sphincter d/t age (decreased muscle tone), neurological damage (congenital, trauma, surgery), increased pressure on/in bladder (lifting, coughing)

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12
Q

Overactive bladder/urge incontinence

A

More than 8 times in 24 hours
Hyperactive detrusor muscle d/t
1. Myogenic disorders of bladders smooth muscle (age, DM, elderly males most affected)
2. Neurogenic disorders (CVA, MS, Parkinson)

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13
Q

Outflow incontinence

A

Increased pressure in bladder exceeds sphincter ability to stay closed
Obstruction (BPH, constipation)
Lesions

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14
Q

Causes for incontinence and the elderly

A 
Capacity of bladder is decreased
Ability of urethra to close is limited
Degeneration of detrusor muscle
Medications
Restricted mobility
Impaired thirst
Comorbid illness/infection
Constipation
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15
Q

Consequences of incontinence and the elderly

A

Social isolation, institutionalization

Predisposes to infections/skin breakdown

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16
Q

Urinary Incontinence Treatment

A 
Bladder training
Encourage fluids to stimulate reflex
Limit caffeine/alcohol
Pelvic floor muscle exercises & Kegel 
Establish patterns of elimination
Medications
Catheterization
Surgery
17
Q

Urinary Tract Infection Definitions

A 
Lower = cystitis (bladder)
Upper = pyelonnephritis
Urethritis = inflammation of the urethra
Ureteritis = inflammation of the ureters
Escherichia coli most common with uncomplicated UTIs
18
Q

Natural Protection

A

Washout phenomenon (drink lots of fluid and it will help wash it out)
Protective mucin layer of bladder (stops bacteria from staying and growing)
Local immune response (immediate antibody response)
Normal bladder/urethral flora
Men - Prostatic fluid (antimicrobial properties)

19
Q

Risk for UTI

A 
Instrumentation 
Neurogenic disorders (spastic/flaccid)
Women - sexually active, post-menopausal or diabetic
Men - prostate disease
Pregnancy: dilation and displacement 
Urinary strictures and/or reflux
Elderly
Poor hygiene/fecal incontinence
20
Q

UTI manifestations

A

Dependent on acute/chronic, upper or lower
Frequency, pain (dysuria), cloudy urine
Lower abdominal or back discomfort
Seldom fever
Often relief in 48 hours on own d/t “washout” of bladder with continuous movement of urine

21
Q

Bladder cancer

A

Cause is unknown but increased risk with

  • Contact with carcinogens (excreted in urine/stored in bladder)
  • Smoking (30-50% of bladder cancers)
  • Chronic bladder infections/stones
  • Parasite “schistosoma” (common to Egypt and Sudan)
22
Q

Bladder cancer groups

A
  1. Superficial bladder cancer (most common)
    Confined to mucosa/submucosa
    Good survival rate if removable, but often recurs
  2. Invasive bladder cancer
    Penetrates deeper layers
    High fatality rate/metastasis
23
Q

Bladder cancer manifestations

A

Hematuria leads to anemia

24
Q

Bladder cancer treatment

A

Dependent on degree of invasion

Excision, cystectomy, radiation, intra-vesicular chemotherapy

Pathophysiology (13 decks)

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