Jan23 M1-VUR, Enuresis and Bladder Dysfunction

Question 1

SS innervation to the bladder and effect

Answer 1

Hypogastric nerve. inhibits detrusor muscle

Question 2

PSS innervation to the bladder and effect

Answer 2

pelvic nerve. contrats the detrusor muscle

Question 3

internal sphincter: type of muscle and innervation

Answer 3

SM

hypogastric nerve. closes it (ANS, involuntary)

Question 4

external sphincter; type of muscle and innervation

Answer 4

striated

pudendal nerve. closes it (voluntary control)

Question 5

dev of urinary control

Answer 5

initially spinal reflexes (bladder distension causes bladder contraction).
then higher cortical centers start to control it too and adult pattern assumed by age 4-5

Question 6

adult pattern of voiding

Answer 6

conscious control of detrusor contraction and external sphincter relaxation

Question 7

incontinence def

Answer 7

leakage during the day

Question 8

signs of voiding dysfunction in kids

Answer 8

• urgency
• frequency (increased or decreased)
• nocturia

Question 9

what can be a cause of weak stream

Answer 9

posterior urethral valves (congenital disease)

Question 10

intermittent stream: in who is it normal

Answer 10

kids under 3

Question 11

holding maneuvers def (seen in kids)

Answer 11

behaviors used to postpone voiding (urgency-standing on tiptoe, crossing the legs, squatting,..)

Question 12

postmicturition dribbling def

Answer 12

leaking (unvoluntary) after micturition

Question 13

etiologies of bladder dysfct in children (3)

Answer 13

neurogenic, anatomic, functional

Question 14

neurogenic causes of bladder dysfct in kids

Answer 14

myelomeingocele, trauma to CNS

Question 15

anatomic causes of bladder dysfct in kids

Answer 15

• ureter insertion distal to the bladder neck

- bladder outlet obsruction (posterior urethral valves, polyuria from renal failure)

Question 16

functional causes of bladder dysfct in kids

Answer 16

(no anat or neuro cause)

• maturation delay
• infantile bladder behavior
• abnormal toilet habits

Question 17

ectopic ureter pathophgy

Answer 17

2nd ureteric bud came off to form a third kidney and this bud inserts below the external sphincter

Question 18

EUI in boys

Answer 18

usually above external sphincter (no dribbling). may get UTI or prostatitis. epididym infection if inserts in other tract

Question 19

EUI in girls

Answer 19

more frequent in girls. small drops (dribbling) coming out of urethra

Question 20

why don’t we pee at night normally

Answer 20

ADH is on

Question 21

questions to evaluate for bladder dysfunction

Answer 21

• growth
• voiding schedule
• polydipsia
• bowel habits

Question 22

useful thing to do to evaluate for bladder dysfct

Answer 22

ask for 3 day history of voiding and drinking + bowel diary. qtfy everything

Question 23

why voiding related to stooling

Answer 23

when you’re constipated, it pushes on the bladder so it doesn’t empty completely

Question 24

2 normal poo shapes and type on the poo scale

Answer 24

type 4: sausage

type 5: chicken nuggets

Question 25

physical exam of bladder dysfct in kids

Answer 25

- height and weight + percentile - BP (htn = renal disease) - neuro (normal reflexes, strength, walking) - fecal or urinary staining-palpable bladder - external genital exam (skin irritation, urethral meatus, gluteal cleft) - psychosocial attitude towards the exam

Question 26

labs investigations in kids with bladder dysfct

Answer 26

``` UA and micro U culture lytes blood gas BUN/Cr ```

Question 27

radiological investigations in kids with bladder dysfct

Answer 27

- lumbosacral spine - pain abdominal films - US - voiding cystourethogram

Question 28

bladder dysfct in kids: when to refer to urology or neurology

Answer 28

- genital exam abnormal - lumbosacral spine prob - neuro exam abnormal - total urinary incontinence

Question 29

Vesico-ureteric reflex (VUR) def

Answer 29

congenital defect of how ureter attaches to the bladder

Question 30

VUR associated with what

Answer 30

malformations, recurrent UTIs, kidney damage, htn

Question 31

VUR treatment

Answer 31

antibiotics + surgery

Question 32

characteristics of uretero-vesical junction (VUR)

Answer 32

- short intravesical ureter - enlarged ureteral orifice - ectopic ureteral orifice - inadequate ureteral SM

Question 33

non pharma treatment for kids with voiding dysfct

Answer 33

time voiding | double voiding

Question 34

how to treat type 1-2-3 of poop (hard)

Answer 34

- more dietary fiber | - laxatives