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MIDS 137 > Ch 4 (normal lower urinary system) > Flashcards

Ch 4 (normal lower urinary system) Flashcards

(63 cards)

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1
Q

What is the urinary bladder?

A

-Muscular collapsible sac in retroperitoneum on the pelvic floor, posterior to pubic symphysis
-Reservoir for urine

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2
Q

How much urine can an adult bladder hold?

A

500mL, but varies depending on age + health

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3
Q

Which lining of the bladder contains rugae for expansion?

A

The inner mucous membrane of transitional epithelium

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4
Q

How does the bladder membrane appear when it is empty?

A

Folded/wrinkled

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5
Q

What is the bladder trigone?

A

Triangular region on bladder floor that contains no rugae + attaches to muscular coat

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6
Q

How many orifices does the bladder trigone have?

A

3 orifices:

-2 ureters
-1urethra

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7
Q

Which aspect of the bladder do the ureters enter at?

A

Posteroinferior

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8
Q

Where is the urethra orifice located in the bladder?

A

Neck of bladder inferiorly

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9
Q

Are bladder walls normally thicker or thinner when it is empty?

A

Thicker

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10
Q

When the bladder is distended, the bladder can rise how many cm above the symphysis pubis?

A

16 cm

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11
Q

Pelvic structures are best seen when the bladder is full or empty?

A

Full/distended

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12
Q

Do we need full bladder for transvaginal + transrectal scanning?

A

Nope, empty!

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13
Q

The UT + VAG are located b/w what 2 structures?

A

B/w bladder + rectum

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14
Q

Where does the bladder + UT lie when the bladder is empty?

A

-Fundus of bladder lies with anterior wall of VAG + CX
-UT rests on superior surface of bladder

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15
Q

In males, the bladder fundus + body are related to what structure?

A

Rectum

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16
Q

In males, the bladder is separated by what structures?

A

Separated above by rectovesical pouch of petironeum + inferolaterally bilaterally by ducus deferens + seminal vesicles

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17
Q

What are ureters?

A

Tubes that transport urine from kidneys to bladder

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18
Q

Are ureters seen on u/s?

A

No, only if dilated

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19
Q

Measurements of ureters?

A

30cm long, 6mm diameter

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20
Q

Ureters enter the bladder at what portion?

A

Posteroinferior portion

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21
Q

If we see long structures in the adnexa, what may we suspect?

A

-Dilated ureters (can follow up to the kidney to identify)
-Fallopian tubes
-Enlongated cystic mass

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22
Q

UPJ vs UVJ location?

A

Ureteropelvic junction: at kidney
Ureterovesical junction: at bladder

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23
Q

Where does constriction occur at the UPJ?

A

As they cross the iliac vessels

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24
Q

Function of the UVJ?

A

Allows urine to enter bladder + prevents it from being regurgitated

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25
Do kidney stones commonly get stuck in ureters?
Yup
26
What is the urethra?
Tube that drains urine from bladder to outside of body
27
Do we see the urethra on u/s?
No, only when abnormal
28
What do voluntary + involuntary sphincters do in regards to the urethra?
Prevent leaking of urine
29
Length + location of female urethra?
3-4cm, posterior to symphysis pubis + anterior to vagina
30
Length of male urethra?
20cm
31
Functions of the male urethra?
Eliminates urine + passage for semen
32
What is micturition?
Voiding of urine
33
How does our body tell our brain we need to urinate?
When bladder exceeds 200-400mL there are stretch receptors that trigger the transmission of impulses to our spinal cord which then initiates conscious desire to expel urine
34
How does our body expel urine?
Combination of voluntary relaxation of external sphincter muscle of bladder, reflex contraction of linear smooth muscle fibers along urethra, and contraction of detrusor muscle squeezes urine out of bladder
35
What is incontinence?
Involuntary emptying of bladder due to aging or trauma to nerves, projection tracts of the cord + brain or motor area of cerebrum
36
6 types of incontinence?
-Stress (increased pressure on bladder such as by exercising, sneezing, etc) -Urge (acute/sudden need to urinate followed by uncontrollable loss of urine) -Overflow (unable to fully empty bladder, frequent urinary dribble occurs) -Functional (unable to reach bathroom in time due to physical limitations) -Mixed (combination of other kinds) -Bedwetting (nighttime, involuntary urination during sleep)
37
What causes urge incontinence?
Infection, diabetes or neurological disorders
38
What type of incontinence is m/c in children?
Bedwetting
39
What is retention?
Inability to empty bladder, catheterization is often necessary (the body doesn't know how much urine to release + is not contracting enough to release it all)
40
2 types of urinary retention?
Obstructive: causes blockage of urine flow (ex kidney stones, prostatomegaly, etc) Non-obstructive: causes a weak bladder muscle + nerve problems that interfere with signals b/w the brain + bladder (due to stroke, pelvic injury, etc)
41
How much water does the pt drink for lower urinary tract exam?
16oz of water 1 hour before exam
42
What are alternative options if a pt is not capable of drinking water before an exam?
-Ask pt not to void before exam -Clamp catheter (typically in-patients) -Catheterization of pt + instilling fluid into bladder (nurse or doctor needs to perform catheterization)
43
What to do if a pt needs to urinate during an exam?
Just take cineclips of sweeps through bladder in both planes and let pt go to the bathroom. We can take images off of the cineclips.
44
M/c u/s method to assess the bladder?
TA
45
U/s methods used to assess the bladder?
-TA (m/c) -EV -Endorectally -Transperineally
46
M/c pt position when scanning bladder?
Supine
47
Why would a pt change positions when scanning the bladder?
When determining mobility of a structure (ex tumours, debris, stones, etc)
48
SF of a distended/full bladder?
-Anechoic -Echogenic smooth walls -Reverb echos anteriorly
49
Bladder wall thickness?
Less than 3mm when full, up to 5mm when empty
50
How should the bladder look in SAG?
Triangular with base parallel with anterior abdominal wall
51
How to measure bladder if exam requires pre + post void measurements?
Ensure we are measuring the bladder the same way both times (either exactly vertical/horizontal or on an angle but 90 degrees across)
52
How does the bladder appear in TRV?
Symmetric - superiorly is rounded, inferiorly is square
53
What is a urinary catheter?
Flexible tube used to empty bladder + collect urine in a drainage bag
54
SF of urinary catheter?
Echogenic circle within bladder lumen
55
How to calculate bladder volume?
L x H x W x 0.52 (measure pre + post void)
56
Bladder capacity decreases in association with what?
Large pelvic masses, urinary + PID, prostatic hypertrophy, radiation therapy, tumour infiltration + after surgeries
57
When would residual volume increase?
With age, atonic bladders, bladder neck obstruction, long term cystitis + advanced invasion by cancer (elderly people can't urinate completely)
58
What should the normal post-void volume be?
Should be 10% or less of what the pre-void volume is
59
What to do if we think we see a ureter on u/s?
-Follow ureters as distally as possible to determine cause of dilatation, then scan up to kidney -Distal ureters will look anechoic + posterior to bladder -Use CD, will not have color -Do height measurements dist, mid + prox to see which area most dilated
60
Which junction are ureteric jets seen at?
UVJ (routine bursts of echoes seen)
61
Time interval jets are seen?
Typically b/w 5-20 seconds (assess in TRV with CD)
62
Where to put the CD box in TRV when looking for jets?
Males: by prostate Females: by vagina
63
What is the point of looking for jets?
Helps us see if there is an obstruction or not

MIDS 137 (14 decks)

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