Chapter 27: Disorders of the Bladder and Lower urinary Tract Flashcards Preview

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Flashcards in Chapter 27: Disorders of the Bladder and Lower urinary Tract Deck (10)
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1
Q

Explain the causes and manifestations that differentiate the two neurogenic bladder disorders, spastic bladder and flaccid bladder.

A

SPASTIC BLADDER: failure to store
Causes:
Spinal cord injury, herniated interverterbral disc, vascular lesions, myelitis

Manifestations
Reflex bladder spasms cause emptying when not full – muscle shrinks
Overflow dribbling, frequency, nocturia, urgency

FLACCID BLADDER: failure to empty
Causes:
Injury to spinal cord or nerves supplying bladder = detrusor muscle areflexia
Lesions of external sphincter result in non-relaxation
Surgery, inflammation/irritation

Manifestations:
Dribbling, retention

2
Q

Describe methods used in the treatment of neurogenic bladder.

A

Catheterization

Bladder training

  • Spastic: tap suprapubic or -genitals
  • Flaccid: suprapubic pressure

Pharmacology

  • Spastic: to decrease detrusor muscle tone
  • Flaccid: increase detrusor muscle tone and/or decrease muscle tone of external sphincter

Surgery

3
Q

Define incontinence and list the categories of this condition.

A

STRESS:
Weak sphincter d/t
-Age
–Decreased muscle tone

  • Neurological damage
  • -Congenital, trauma, surgery
  • Increased pressure on/in bladder
  • -Lifting, coughing, etc.
OVERACTIVE BLADDER/ URGE INCONTINENCE
Hyperactive detrusor muscle d/t
-Myogenic disorders of bladder’s smooth muscle 
--Age, diabetes
--Elderly males most affected
  • Neurogenic disorders
  • -CVA, MS, Parkinson

OVERFLOW:
Increased pressure in bladder exceeds sphincter ability to stay closed

  • Obstruction (enlarged prostate)
  • -BPH, constipation
  • lesions
4
Q

List the treatable causes of incontinence in the elderly.

A
Causes:
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
5
Q

Cite organisms most responsible for urinary tract infections (UTIs) and state why urinary catheters, obstruction, and reflux predispose to infections.

A

Escherichia coli most responsible for UTI

Staphylococcus saprophyticus in uncomplicated UTIs and both non–E. coli gramnegative rods (Proteus mirabilis, Klebsiella species, Enterobacter species, and Pseudomonas aeruginosa) and gram-positive cocci (Staphylococcus aureus) in complicated UTIs

Obstruction and reflux are other factors that increase the risk for UTIs. Any microorganisms that enter the bladder normally are washed out during voiding. When outflow is obstructed, urine remains in the bladder and acts as a medium for microbial growth; the microorganisms in the contaminated urine can then ascend along the ureters to infect the kidneys

Urinary catheters are a source of urethral irritation and provide a means for entry of microorganisms into the urinary tract.

6
Q

List three physiologic mechanisms that protect against UTIs.

A

washout phenomenon

Protective mucin layer of bladder

Local immune response

Normal bladder/urethral flora

Men: prostatic fluid (antimicrobial properties)

7
Q

Described the predisposing factors and manifestations of UTIs

A
Instrumentation 
Neurogenic disorders (spastic/flaccid)
Sexually active, post-menopausal, or diabetic women
Men with prostate disease
Pregnancy (dilation & displacement)
Urinary strictures and or reflux
Elderly
Poor hygiene/fecal incontinence

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

8
Q

Compare the signs and symptoms of upper and lower UTIs.

A

Upper (kidney)
Lower (bladder)
it is dependent on acute or chronic

9
Q

State the most common sign of bladder cancer.

A

Manifestations:
Hematuria & therefore anemia
Incontinence, frequency
Dysuria or painless

10
Q

Discuss the treatment of bladder cancer and how it relates to the extent of the lesion.

A

Treatment (dependent on degree of invasion)

Excision, cystectomy, radiation, intravesicular chemotherapy