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Medicine Year 2 > Repro Topic 4 - Bladder > Flashcards

Repro Topic 4 - Bladder Flashcards

1
Q

Describe the afferent and efferent pathways for control of bladder function

A
  • Efferent
    • Sympathetic - hypogastric nerve (T12-L2)
    • Parasympathetic - pelvic nerve (S2, 3, 4)
  • Afferent - pelvic, hypogastric and pudendal nerves from bladder wall
    • A delta (normal) and C (pathological) fibres
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2
Q

How does urine retention lead to hydronephrosis?

A
  1. Bladder filling, increased upper tract pressure
  2. Ureters dilate, peristalsis lost, ureteric drainage dependent on gravity
  3. Increasing pressure = decreasing renal function
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3
Q

Describe the voiding phase of micturition

A
  • Voluntary relaxation of external sphincter
  • Pontine micturition relaxes internal first
  • Parasympathetic action causes detrussor contraction, bladder empties
  • Assissted by contraction of abdominal muscles - increases the pressure in the bladder
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4
Q

What is the role of higher centres in the brain in the micturition reflex?

A
  • Keep micturition reflex inhibited except when micturition is desired
  • Contraction of external sphincter
  • When time to urinate high centres send signals to sacral micturition centre which stimulates the micturation reflex
    • Coordinates: spino-bulbar-spinal reflex, detrussor contraction, urethral relaxation
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5
Q

Describe the structure of the male urethra

A
  • 15-20cm long, carries urine and semen
  • 4 parts - pre-prostatic, prostatic, membraneous, spongey
    • Prostatic - prostatic and ejaculatory glands empty into
    • Membraneous - surrounded by external urethra sphincter
    • Spongey - through bulb and corpus spongeosum, ends at external urethral orifice, bulbourethral glands empty into
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6
Q

Describe the venous drainage of the ureters

A

Follows arteries

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7
Q

Describe the higher centres in the brain involved in micturition

A
  • Pontine micturition (Barrington’s nucleus)
    • Dorsolateral pons, collection of neuronal cell bodies
    • Send axons via lateral columns to sacral micturition centre (intermediolateral nucleus and Onuf’s nucleus)
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8
Q

Describe the structure of the walls of the bladder

A
  • Rugae (folds) allow for expansion - volume can increase without pressure changing
  • Mucosa - transitional epithelium, lamina propria
  • Submucosa
  • Detrussor muscle
  • Adventitia
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9
Q

Describe the process of the micturition reflex

A
  • Bladder fills until it reaches critical pressure, stretch receptors activated, signals from bladder to spinal cord via sensory afferents (pelvic nerves)
  • Activates autonomic spinal reflex (parasympathetic + sympathetic activity), can be overriden by higher centres in the brain
  • Causes contraction of the detrussor muscle, at partial filling contractions relax spontaneously - allows more filling
  • With continued filled reflexes become more frequent
  • If signals from brain are stronger than voluntary contraction of the external sphincter micturition occurs
  • If not, bladder fills further and further and reflex becomes stronger
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10
Q

What is the effect of the parasympathetic efferent pathway on the bladder?

A

Contraction of detrussor muscle - micturition

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11
Q

Describe the innervation of the ureters

A

Renal, testicular/ovarian and hypogastric plexus

Sensory fibres –> T11-L2

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12
Q

Describe the arterial supply of the ureters

A
  • Renal and testicular/ovarian arteries from the abdominal aorta
  • Superior and inferior vesical arteries from the internal iliac artery
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13
Q

List the stages of micturition

A
  • Filling
  • Micturition reflex
  • Voiding
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14
Q

List the functions of the bladder

A
  • Store urine at low pressure (no sensation)
  • Empty fully at socially convenient time
  • Reciprocal contraction/relaxation
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15
Q

Describe the arterial supply of the male urethra

A
  • Prostatic - inferior vesicle from internal iliac artery
  • Membraneous/spongey - bulbourethral from internal pudendal artery
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16
Q

Describe the lymphatic drainage of the bladder

A

Vesical, external iliac, internal iliac and common iliac nodes

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17
Q

What are the causes of bladder outflow obstruction?

A
  • Men - prostatic hyperplasia
  • Women - pelvic organ prolapse (pregnancy), pelvic masses
  • Both -
    • Neurological disease - failure of relaxation of external sphincter
    • Bladder tumours, stones, urethral strictures (e.g. scar tissue)
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18
Q

Describe the musculature of the bladder

A
  • Lined by smooth muscle - detrussor
    • Spiral, longitudinal and circular layers
  • Bundles around neck = internal urethral sphincter (involuntary)
  • More distal = external urethra sphincter (after prostate in males) - voluntary, skeletal muscle, in ureogenital diaphragm
  • Internal controlled by ANS, external by voluntary control
19
Q

Describe the innervation of the female urethra

A

Vesical plexus and pudendal nerve, visceral afferent nerve in pelvic splanchnic nerves

20
Q

What is the function of the urethra?

A

Drain urine from bladder to external opening (in perineum)

21
Q

Describe the lining of the male urethra

A
  • Pre-prostatic, prostatic - transitional
  • Membraneous, proximal spongey - pseudostratified columnar
  • Distal spongey - stratified squamous
22
Q

Where is Onuf’s nucleus found? What is its function?

A

S2, 3, 4 - somatic, anterior horn

Maintains continence

23
Q

What is the function of the afferent pathway from the bladder?

A

Signals to brain when bladder is full

24
Q

Describe the gross anatomy of the bladder

A
  • Hollow muscular organ - body, neck and apex
    • Neck connects to urethra
  • Normal capacity - 400-500ml (can hold more - backflow risk)
  • Held at neck by puboprostatic (male) or pubovescical (female) ligaments, attach to pubic symphysis
  • Base is trigone, has ureteric openings, less mobile and more sensitive to pain
25
Q

Describe the structure of the female urethra

A
  • 4 cm long (increased risk of UTI/incontinence e.g. due to pregnancy)
  • Opening external urethral orifice = vestibule
  • 2 mucous glands at distal end - Skene’s glands
26
Q

What is the effect of the sympathetic efferent pathway on the bladder?

A

Causes relaxation of detrussor muscle - urine retention

27
Q

Describe the path of the ureters

A
  • Begin abdominally as continuation of the renal pelvis, end in pelvic cavity where they drain into the bladder
    • Descend through abdomen, along anterior surface of psoas major, retroperitoneal
    • At sacroiliac joint cross pelvic brim into pelvic cavity
    • Run down lateral pelvic wall
    • Peirce lateral wall of bladder
28
Q

Describe the innervation of the male urethra

A

Prostatic plexus - parasympathetic, sympathetic + viseral afferent fibres

29
Q

What are the consequences of chronic urine retention?

A
  • Upflow from bladder can cause irreversible kidney damage - hydronephritis
  • Usually only 1 kidney affected
  • Irreversible tubular atrophy if obstruction not recognised + corrected - blunting of papillae, interstitial fibrosis
  • Increased susceptibility to UTIs/urolithiasis (struvite) - stagnant urine
30
Q

Describe the arterial supply of the bladder

A

Superior and inferior vesical branches of the internal iliac artery

+ uterine/vaginal arteries in females

31
Q

How can the intactness of the sacral micturition reflex be tested?

A

Check the bulbocavernous reflex

32
Q

Describe the filling phase of micturition

A

Increasing volume of urine, walls stretch to accommodate, little increase in pressure (= compliance)

33
Q

Describe the lining of the female urethra

A

Proximal 2/3 = transitional epithelium

Distal 1/3 = Stratified squamous epithelium

34
Q

Describe the blood supply of the female urethra

A

Arteries = Internal pudendal, vaginal and inferior vesical branches of vaginal arteries

Veins follow arteries

35
Q

What is the function of the ureters?

A

Transport urine from the kidneys to the bladder

36
Q

How does spinal shock cause bladder dysfunction?

A
  • Decreases excitability below injury
  • No somatic reflexes and flaccid muscle paralysis
  • Acontractile, areflexic bladder, sphincter functioning
  • Urine retention
  • Lasts days-months
37
Q

How is bladder dysfunction in spinal shock treated?

A

Catheter - suprapubic or clean intermittent self catheterisation

38
Q

What controls the micturition reflex?

A

Autonomic reflex under partial voluntary control

39
Q

How is the entry of the uterers of the bladder functionally beneficial?

A

Pierce lateral wall of bladder at oblique angle - one-way valve to prevent backflow

40
Q

List causes of bladder dysfunction

A
  • Spinal shock
  • Multiple sclerosis
  • Neuropathic detrussor hyperreflexia e.g. in spina bifida
  • Parkinson’s
41
Q

What is the function of the sacral micturition centre?

A

Parasympathetic, relaxation of sphincter, voiding

42
Q

Describe the venous drainage of the bladder

A

Vesical venous plexus, drains to the internal iliac vein

43
Q

Describe the structure of the ureters

A
  • 2 bilateral thick tubes
  • 25cm long
  • Stratified transitional epithelium
  • Walls lined with smooth muscle, contracts to produce peristaltic waves, push urine to bladder
44
Q

Describe the venous drainage of the male urethra

A

Inferior vesicle vein, middle rectal vein, internal pudendal vein

Medicine Year 2 (41 decks)

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