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MET 2 > Micturition > Flashcards

Micturition Flashcards

1
Q

Where does sensory feedback from the brain regarding whether or not its socially acceptable to urinate travel along

A

Pelvic nerves

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2
Q

What are the roots of the pelvic nerves

A

S2,3,4

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3
Q

Where does micturation centre send impulses if it is socially acceptable to urinate

A

Through pudendal nerve to sphincter

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4
Q

2 things that the bladder does

A

Emptying and storage

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5
Q

What happens to the bladder during bladder villing

A

Relaxed detrusor
Urethra contracted
Pelvic floor contracted

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6
Q

What happens during the emptying phase to the bladder

A

Detrusor contracts
Urethra relaxes
Pelvic floor relaxes

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7
Q

How many times does the average adult wee per day

A

4

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8
Q

How much urine is passed a day

A

1500ml

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9
Q

What causes normal bladder contraction

A

Ach released from cholinergic nerves

Stimulates muscarinic receptors on the detrusor smooth muscle

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10
Q

What are the receptor abnormalities seen in a ‘weak’ bladder

A

Receptors are not upregulated

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11
Q

What is the problem with a small thickened bladder

A

High pressure during storage phase which can transmit up to kidneys killing them

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12
Q

2 categories of lower urinary tract symptoms

A
  • Storage symptoms

- Voiding symptoms

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13
Q

Some examples of storage symptoms (lower urinary tract)

A

Frequency
Nocturia
Urgency
Urge incontinence

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14
Q

Some examples of voiding/ obstructive symptoms

A

Hesistancy, straining, poor floow, intermittency, incomplete emptying, terminal dribbling, haematuria

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15
Q

What is overactive bladder syndrome

A

Urgency, with or without incontinence, usually with frequency and nocturia

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16
Q

Define nocturia

A

Excessive urination at night

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17
Q

What are the values for mild symptoms on IPSS

A

0-7

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18
Q

What are values for medium and severe symptoms on IPSS

A

8-19

20-35

19
Q

Are men or women more affected by urine problem

A

Both

20
Q

What investigations can be done in patients with urine problems

A
  • Inspect fresh urine sample
  • Dipstick
  • FBC
    Uroflowmetry and post void residual volume
  • Urodynamics
  • XB KUB
  • Ultrasound
  • CT KUB
  • Nuclear imaging
21
Q

What problems with ‘outlet’ can occur

A 
Bladder neck problems
Prostate problems
Stricture
Meatus
Foreskin tightening
22
Q

What problems with the pump can occur

A

Bladder- OAB, sensory, failure
Cardiac
Medication

23
Q

What problems with the constituents can occur

A

UTI
Cancer
Inflammation
Stones

24
Q

How does caffeine make your bladder act

A

Releases calcium stores from the golgi apparatus in the bladder wall
Makes bladder contraction more likely

25
Q

How long does the bladder store urine for

A

3-4 hours

26
Q

Give some examples of medical therapy for urine problems

A

Alpha blockers (stretchers)
5-alpha reductase inhibitors (shrinkers)
PDE5 inhibitors
Antimuscarinics

27
Q

What is the gold standard for surgery

A

TURP

This is when electric loop carves out prostate chips

28
Q

What are the risk factors of TURP

A
  • 1:10 need blood transfusion
  • Electrolyte problems afer
  • 5% chance of affecting erections
29
Q

What is HoLep?

A

Modern laser operation

Better at tissue removal

30
Q

What are the pros of HoLeps

A

Lesser risk of transfusion, electrolyte probs, erection probs

31
Q

What is a urolift

A

Newest technique, stapling prostate back

32
Q

What is stress urinary incontinence

A

Leakage on effort or exersion

33
Q

What is urge incontinence

A

Leakage accompanied by urgency

34
Q

How does the bladder/ muscles behave in stress incontinence

A

Cough/ strain

Pressure doesn’t go around the bladder as it should but forces bladder down

35
Q

How does bladder/ muscles behave in urge incontinence

A

No problem with support, but overactive waves

Easy to force urine through and out

36
Q

What conservative measures can be taken to treat urinary problems

A

Fluid intake
Caffeine
Pads
Timed voiding

37
Q

What are the three main classes of medication for OAB/ urge incontinence

A
  • Anticholinergenics
  • B3 adrenergenics
  • Botulum toxin A
38
Q

Give examples of anticholingeric drugs used to treat OAB/ urge incontinence

A

Oxybutymin
Solifenacin
Tolterodine
Fesoterodine

39
Q

How do anticholinergic drugs work to treat OAB/ urge incontinence

A

Block acetyl choline in parasympathetic nerves but can also block elsewhere (salivary glands)

40
Q

How do beta adrenergic drugs work

A

B3 adrenoceptors upregulated in OAB

Hypertension may be an issue

41
Q

How do botulumin toxin A work

A

Fuses with synaptic vesicles in motor end plate

Issues with hypercontinence

42
Q

Do lesions above the pontine micturition cause problems

A

No- they are safe

43
Q

Are lesions below T12 safe or unsafe in terms of urination

A

Bladder doesn’t squeeze well but sphincter works so you dribble out- safe

44
Q

In between pontine micturition centre and T12 safe or nto?

A

UNsafe

Uncooridated so high pressures in the restting bladder

MET 2 (32 decks)

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