Class 5 chapter 27 Flashcards
(24 cards)
Micturition Reflex
Begins when bladder contains 150-250 mL of urine
Spastic Bladder
Failure to store
Spastic Bladder causes
Spinal cord injury, herniated interverterbral disc, vascular lesions, myelitis (inflammation of the spinal cord)
Spastic Bladder manifestations
Reflex bladder spasms cause emptying when not full (muscle shrinks)
Overflow dribbling, frequency, nocturia, urgency.
Flaccid Bladder
Failure to empty
Flaccid Bladder causes
Injury to spinal cord or nerves supplying bladder = destrusor muscle areflexia
Lesions of external sphincter result in non-relaxation
Surgery (anaesthetic), inflammation/irritation
Flaccid Bladder manifestations
Dribbling, retention
What methods can be used to determine if a patient has a flaccid bladder?
Post void residual (PVR)
Bladder scan
Catheterization (in and out)
Ultrasound
Neurogenic Bladder Treatment
- Catheterization
- Bladder training
Spastic - tap suprapubic or genitals
Flaccid - suprapubic pressure - Pharmacology
Spastic - to decrease detrusor muscle tone
Flaccid - to increase detrusor muscle tone and/or decrease muscle tone of external sphincter - Surgery
Urinary Incontinence: Types/Causes
- Stress
2. Overactive bladder/urge incontinence
Stress incontinence
Weak sphincter d/t age (decreased muscle tone), neurological damage (congenital, trauma, surgery), increased pressure on/in bladder (lifting, coughing)
Overactive bladder/urge incontinence
More than 8 times in 24 hours
Hyperactive detrusor muscle d/t
1. Myogenic disorders of bladders smooth muscle (age, DM, elderly males most affected)
2. Neurogenic disorders (CVA, MS, Parkinson)
Outflow incontinence
Increased pressure in bladder exceeds sphincter ability to stay closed
Obstruction (BPH, constipation)
Lesions
Causes for incontinence and the elderly
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
Consequences of incontinence and the elderly
Social isolation, institutionalization
Predisposes to infections/skin breakdown
Urinary Incontinence Treatment
Bladder training Encourage fluids to stimulate reflex Limit caffeine/alcohol Pelvic floor muscle exercises & Kegel Establish patterns of elimination Medications Catheterization Surgery
Urinary Tract Infection Definitions
Lower = cystitis (bladder) Upper = pyelonnephritis Urethritis = inflammation of the urethra Ureteritis = inflammation of the ureters Escherichia coli most common with uncomplicated UTIs
Natural Protection
Washout phenomenon (drink lots of fluid and it will help wash it out)
Protective mucin layer of bladder (stops bacteria from staying and growing)
Local immune response (immediate antibody response)
Normal bladder/urethral flora
Men - Prostatic fluid (antimicrobial properties)
Risk for UTI
Instrumentation Neurogenic disorders (spastic/flaccid) Women - sexually active, post-menopausal or diabetic Men - prostate disease Pregnancy: dilation and displacement Urinary strictures and/or reflux Elderly Poor hygiene/fecal incontinence
UTI manifestations
Dependent on acute/chronic, upper or lower
Frequency, pain (dysuria), cloudy urine
Lower abdominal or back discomfort
Seldom fever
Often relief in 48 hours on own d/t “washout” of bladder with continuous movement of urine
Bladder cancer
Cause is unknown but increased risk with
- Contact with carcinogens (excreted in urine/stored in bladder)
- Smoking (30-50% of bladder cancers)
- Chronic bladder infections/stones
- Parasite “schistosoma” (common to Egypt and Sudan)
Bladder cancer groups
- Superficial bladder cancer (most common)
Confined to mucosa/submucosa
Good survival rate if removable, but often recurs - Invasive bladder cancer
Penetrates deeper layers
High fatality rate/metastasis
Bladder cancer manifestations
Hematuria leads to anemia
Bladder cancer treatment
Dependent on degree of invasion
Excision, cystectomy, radiation, intra-vesicular chemotherapy
