Neurological control of urinary function Flashcards
(24 cards)
What are the three main muscles in urination?
Detrusor m (smooth) internal urethral sphincter (smooth) External urethral sphincter (skeletal)
What are the thee main nerves involved in micturition?
Hypogastric nerve Pelvic nerve Pudendal nerve
Where does the hypogastric nerve leave the spinal cord?
L1-L4
Where is the micturition centre?
In the pons
Where do the pelvic nerve and pudendal nerve leave the spinal cord?
S1-S3
The sympathetic nervous system predominates during the ******* phase
Storage
The parasympathetic predominated during the ***** phase
What adrenergic receptors are in action during the storage phase and where are they found?
Alpha adrenergic on the internal urethral sphincter (sm muscle contraction)
Beta fibres on the detrussor muscle (sm muscle relaxation)
What muscarinic cholinergic fibres are in action during the voiding phase?
ACh receptors on the detrusor muscle causing it to contract
Which nerve stimulates the alpha and beta receptors during the storage phase?
The hypogastric nerve
Which nerve is somatic during the storage phase?
Pudendal nerve - contracts external urethral sphincter
Which nerve provides the muscarinic cholinergic stimulation to the bladder during the voiding phase?
Pelvic nerve
Where would the lesion be if you had a UMN bladder?
Between the pons and L7
How would the bladder feel on palpation if you had a UMN bladder?
INCREASED TONE
Would feel turgid, easily palpable
Increased urinary sphincter tone, difficult to express
careful - rupture
Where would you have a lesion in an LMN bladder?
Sacral spinal cord or sacral nerves
How would an LMN bladder feel?
Decreased tone, flaccid, difficult to feel, dificult to express
Decreased urinary sphincter tone
What are the problems associated with neurogenic bladder problems?
Incontinence
Urine scalding
Urine stasis
UTIs
Detrusor atony
Pain/discomfort
Which situation leads to urine dribblin, UMN or LMN?
Both can!
How might you physically assist with bladder dysfunction?
Manual expression
Catheterisation - indwelling or intermittent
Cystotomy tube
What is the use of Diazepam in the pharmacological treatment of bladder problems?
Centrally acting skeletal muscle relaxant - RELAXES the external urethral sphincter
(good for pelvic nerve problem)
What is the role of bethanechol in manipulation of bladder function?
Muscarinic cholinergic agonist - contraction of detrusor muscle
Which two drugs can be used to relax the internal urethral sphincter?
Phenoxybenzamine
Prazosin
Both are alpha adrenergic antagonists
Which drug can be used to increase internal urethral sphincter tone?
Phenylpropanolamine
Mixed alpha and beta adrenergic agonist
Used to treat incontinence
