Anatomy of Urinary Incontinence and Renal Pain

Question 1

What conveys sensory nerve fibres from body wall to CNS?

Answer 1

somatic sensory

Question 2

What conveys sensory nerve fibres from organs to CNS?

Answer 2

visceral afferent

Question 3

What conveys motor from CNS to body wall?

Answer 3

somatic motor

Question 4

What conveys motor from CNS to organs?

Answer 4

parasympathetic or sympathetic

Question 5

Sympathetic nerve fibres leave the CNS only within the spinal nerves between spinal cord levels of what, and what is this called?

Answer 5

T1-L2 (“thoracolumbar outflow”)

Question 6

Which cranial nerves are parasympathetic?

Answer 6

III, VII, IX & X

Question 7

Parasympathetic nerve fibres which innervate the kidneys & ureter are carried within which nerves?

Answer 7

vagus nerves

Question 8

Parasympathetic nerve fibres which innervate the bladder are carried within which nerves?

Answer 8

the pelvic splanchnic nerves

Question 9

Where is bladder pain normally felt?

Answer 9

suprapubic region (midline)

Question 10

Pain from a calculus obstructing the ureter can often be felt where?

Answer 10

radiating from “loin to groin”, on the affected side

Question 11

Pain from the kidney itself (e.g. in acute hydronephrosis) is felt where?

Answer 11

In the “loin”: posterior aspect of the flank region, on the affected side

Question 12

Pain from the (perineal part of the) urethra is usually felt where?

Answer 12

localized to perineum

Question 13

Visceral afferents from the KIDNEYS

enter the spinal cord approx. between which vertebra levels?

Answer 13

T11 and L1

Question 14

Give 5 differentials for loin pain.

Answer 14

skin origin (e.g. herpes zoster)
muscular 
vertebrae 
spinal nerve root compression
lower lobe pneumonia

Question 15

Visceral afferents from the URETER

enter the spinal cord approx. between which vertebra levels?

Answer 15

T11 and L2

Question 16

Differentials of groin pain?

Answer 16

hernias (inguinal or femoral)
lymphadenopathy
testicular pathology

Question 17

Visceral afferents from the BLADDER

enter the spinal cord approx. between which vertebra levels?

Answer 17

T11 and L2

Question 18

How Do Visceral Afferent & Somatic Sensory Nerve Fibres get from the Urethra to the CNS?

Answer 18

visceral afferents enter back at spinal cords levels S2,S3,S4

Question 19

Differential diagnosis of perineal pain?

Answer 19

vaginal tear
anal canal fissure
perineal genital ulcers (e.g. herpes)

Question 20

Differential diagnosis of scrotal pain

Answer 20

skin lesions

strangulated inguinal hernia

Question 21

How Do Pain Fibres get from the Testis to the CNS?

Answer 21

visceral afferents enter back at spinal cords levels T10-11

Question 22

Where can testicular pain also present?

Answer 22

localised to the scrotum and/or groin (L1 region)

Question 23

Describe pain from the kidneys themselves.

Answer 23

dull, achy type pain in the loin (posterior flank region)

Question 24

Describe pain from the ureters.

Answer 24

if obstruction, “loin to groin” pain

Question 25

Describe pain from the bladder.

Answer 25

usually dull, achy suprapubic pain

Question 26

Describe urethral pain.

Answer 26

distal urethra (that within the perineum) is felt localised and is a relatively sharp pain within the perineum

Question 27

Describe pain from the testis.

Answer 27

often felt in scrotum but can radiate to the groin and the anterior lower abdomen (can also initially present in one of the latter two)

Question 28

The nerve fibres entering and leaving spinal cord levels S2-S4 are key in the control of what?

Answer 28

micturition (urine flow)

Question 29

As the bladder fills, this is sensed by stretch receptors at the end of which fibres?

Answer 29

visceral afferent nerve fibres

Question 30

Describe what happens to the detrusor muscle during micturition.

Answer 30

The detrusor muscle contracts (parasympathetic)

Question 31

Describe what happens to the internal urethral sphincter during micturition.

Answer 31

relaxes (parasympathetic)

Question 32

Describe what happens to the external urethral sphincter during micturition.

Answer 32

relax

Question 33

Describe what happens to the levator ani muscles during micturition.

Answer 33

relax

Question 34

Describe what happens to the anterolateral abdominal wall muscles during micturition.

Answer 34

contract to increase intra-abdominal pressure and force urine out of the external urethral orifice (somatic motor nerve fibres)

Question 35

Where does the sciatic nerve arise from?

Answer 35

the sacral plexus (nerve roots L4-S3)

Question 36

What is the pudendal nerve from?

Answer 36

S2,S3,S4

Question 37

Where does the femoral nerve go?

Answer 37

anterior compartment of thigh

Question 38

Where does the obturator nerve go?

Answer 38

medial compartment of thigh

Question 39

Where does the sciatic nerve go?

Answer 39

posterior compartment of thigh via the gluteal region

Question 40

What does the tibial nerve supply?

Answer 40

muscles of the posterior part of the leg and the intrinsic muscles of the foot

Question 41

What does the sciatic nerve split into?

Answer 41

tibial and common fibular nerves

Question 42

What does the femoral nerve become?

Answer 42

saphenous nerve

Question 43

What supplies sensation to plantar aspect of foot?

Answer 43

tibial nerve

Question 44

What supplies sensation to the lateral aspect of the foot?

Answer 44

sural nerve (formed from the tibial and common fibular nerves)

Question 45

What supplies the “1st web space” in the foot?

Answer 45

deep fibular nerve

Question 46

What is pelvic kidney?

Answer 46

one kidney fails to ascend

Question 47

What is horseshoe kidney?

Answer 47

kidney trapped beneath IMA