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Renal > Urinary Continence and Renal Pain > Flashcards

Urinary Continence and Renal Pain Flashcards

1
Q

important nerve functions of the renal system?

A 
motor
- ureter peristalsis
- bladder contraction
- urethral sphincter control
sensory 
- pain from any part of tract
motor and sensory
- urinary continence
- lumbar and sacral plexuses to perineum and lower limbs
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2
Q

what are the 5 modalities (types) of nerve fibre?

A

somatic sensory - sensory for body wall
somatic motor - motor to body wall muscles
visceral afferent - sensory for organs
parasympathetic - motor to organs, smooth muscle and glands
sympathetic - motor to organs, smooth muscle and glands

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3
Q

what nerve modalities are associated with renal system motor function?

A

ureteric peristalsis and bladder contraction = sympathetic/parasympathetic
urethral sphincter control = sympathetic/parasympathetic (internal sphincter) and somatic motor (external sphincter and levator ani)

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4
Q

what nerve modalities are involved in sensory renal system function?

A 
visceral afferent (pain from renal structures - kidneys, ureters, bladder, testis, urethra in pelvis)
pain from urethra in perineum = somatic sensory
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5
Q

why is pain from perineal urethra carried by somatic sensory?

A

perineum is body wall region

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6
Q

what nerve modalities are involved in urinary continence?

A

symp/parasymp/somatic motor/visceral afferent

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7
Q

how do nerve fibres communicate with the CNS?

A

carried either in cranial nerves or spinal nerves
somatic motor and sensory are carried the entire length from origin to destination within these
sympathetic and parasympathetic and visceral afferents use them for small portions to get in and out of CNS

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8
Q

how do sympathetic nerves fibres leave the CNS?

A

only within the spinal nerves between T1 and L2 and then enter the sympathetic chain (thoracolumbar outflow)

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9
Q

how do sympathetic nerve fibres reach their target?

A

reach smooth muscle/glands of the body wall within spinal nerves
reach smooth muscle/glands of body (not body wall) within nerves called splanchnic nerves (cardiopulmonary or abdominopelvic)
reach smooth muscle/glands of head by hitching a ride with arteries which supply same structures

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10
Q

the sympathetic chain runs between which vertebrae, what does this mean?

A

runs entire length of vertebral column

therefore can convey sympathetic fibres to all 31 pairs of spinal nerves

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11
Q

how do sympathetic nerve fibres get from CNS to the kidneys, ureters and bladder?

A

leave spinal cord between T10-L2
enter sympathetic chains (bilaterally) but do not synapse
leave sympathetic chain within abdominopelvic splanchnic nerves
synapse at the abdominal sympathetic ganglia which are located around abdominal aorta
post synaptic sympathetic fibres travel from the abdominal sympathetic ganglia onto a peri-arterial plexus (plexus on surface of artery) that follows the course of the arteries towards the respective organs

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12
Q

how do parasympathetic nerves leave the CNS?

A

leave the CNS only within 4 cranial nerves (3, 7, 9, 10) and the sacral spinal nerves (only briefly)
= craniosacral outflow

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13
Q

how do parasympathetic fibres reach the body wall?

A

don’t innervate body wall

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14
Q

how do parasympathetic fibres reach smooth muscle/glands of the head?

A

via cranial nerves

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15
Q

how do parasympathetic nerves reach smooth muscle/glands of the hindgut and pelvic organs?

A

via splanchnic nerves

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16
Q

how do parasympathetic nerve fibres get from CNS to kidneys, ureters and bladder?

A

parasympathetic to kidneys and bladder innervation is carried within vagus nerve
bladder innervation carried within pelvic splanchnic nerves (sacral spinal nerves - S2,3,4)
fibres from both reach organs via periarterial plexus, same as sympathetic

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17
Q

how do somatic motor nerve fibres get from CNS to kidneys, ureters and bladder?

A

they don’t go to any of these structures, only to body wall structures
therefore the only renal structures supplied by somaic nerves are those in the perineum (urethra, urethral sphincter, levator ani)

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18
Q

where is pain from the kidney felt?

A

loin (posterior flank region)

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19
Q

where is pain from calculus obstructing the ureter felt?

A

can be felt radiating from loin to groin

20
Q

where is pain from bladder usually felt?

A

suprapubic region (midline)

21
Q

where is pain from perineal urethra felt?

A

usually localised to urethra

22
Q

how do visceral afferent nerve fibres get from kidneys to CNS?

A

run alongside sympathetic fibres back to the spinal cord

enter spinal cord approx. between T11 and L1

23
Q

why is kidney pain felt in the loin?

A

visceral afferents from the kidney enter the spinal cord at level T11-L1
= pain in T11 and L1 dermatomes

24
Q

how do visceral afferents get from ureters to CNS?

A

run alongside sympathetic fibres back to the spinal cord and enter between T11 and L2
- therefore ureter pain can be felt anywhere along this path

25
Q

how do visceral afferents get from bladder to CNS?

A

part of bladder touching perineum
- visceral afferents run alongside sympathetics back to spinal cord and enter between T11-L2
= suprapubic pain
rest of bladder
- run alongside parasympathetic nerve fibres back to spinal cord and enter at levels S2,3,4
= can sometimes get referred pain to buttocks)

26
Q

how do visceral afferents and somatic sensory get from urethra to CNS?

A

visceral afferents (proximal urethra)
- run alongside parasympathetics to spinal cord S2,3,4
somatic sensory (remaining urethra)
- carried within pudenal nerve back to spinal cord S2,3,4
= pain localised to perineum

27
Q

how do pain fibres from testes get to CNS?

A

due to embryological descent, visceral afferents run alongside sympathetic fibres back to spinal cord T10-11
however due to close relationship to scrotal (body) wall, pain from testes can also present localised to scrotum and/or groin (L1)

28
Q

how does pain from each renal structure present?

A 
kidneys = dull, achy loin pain
ureters = loin to groin
bladder = dull achy suprapubic
urethra = distal - sharp pain in perineum
testes = often in scrotum, can radiate to groin and anterior lower abdomen
29
Q

nerve fibres entering spinal cord at which levels are most important in urinary continence and why?

A

S2,3,4
carry visceral afferents, parasympathetics (pelvic splanchnic nerves) and pudenal nerve (somatic, motor and sensory fibres)

30
Q

describe the nervous control of the bladder

A

as the bladder fills, this stretch is sensed by stretch receptors at the end of visceral afferent nerve fibres
this info then relayed to CNS via S2,3,4 spinal cord levels
there is a reflex at this point to empty the bladder by stimulation of the detrusor muscle and inhibition of the internal urethral sphincter (only in males)

31
Q

how is bladder control in adults and potty trained children different?

A

reflex is overridden
action potentials within inhibitory nerve fibres from the cortex pass inferiorly and inhibit this reflex
we can also voluntarily contract the external urethral sphincter and levator ani muscle

32
Q

what happens when it is appropriate to urinate?

A

cerebral inhibition of the reflex is lifted and there is a co-ordinated contraction/relaxation of various muscles

  • detrusor contracts (parasympathetic)
  • internal and external urethral sphincters relax (parasympathetic and somatic motor respectively)
  • anterolateral abdo wall muscles contract to increase intra-abdominal pressure and force urine out (somatic motor)
33
Q

what forms plexuses and what emerges from them?

A

formed from anterior rami of spinal nerves
named nerves emerge form nerve plexuses
names nerves are usually spinal nerves and therefore contain
- somatic sensory
- somatic motor
- sympathetic

34
Q

name the nerves of the lumbar plexus

A 
iliohypogastric = L1
ilioinguinal = L1
lateral cutaneous nerve of the thigh = L2, L3
genitofemoral nerve = L1, L2
femoral nerve = L2-L4
obturator nerve = L2-L4
35
Q

what are the 2 main nerves of the sacral plexus?

A

sciatic nerve = L4-S3

pudenal nerve = S2-S4

36
Q

path of femoral nerve?

A

L2,L3,L4

passes under inguinal ligament into anterior compartment of thigh

37
Q

path of obturator nerve?

A

L2,L3,L4

passes through obturator foramen (pelvis) into medial compartment of thigh

38
Q

path of sciatic nerve?

A

L4-S3
passes into posterior compartment of the thigh via gluteal region
splits into tibial and common fibular in popliteal fossa
tibial supplies muscles of posterior compartment of leg and intrinsic muscles of foot
common fibular splits into superficial and deep
- superficial = lateral leg
- deep = anterior leg

39
Q

what nerve supplies sensation to plantar aspect of foot?

A

tibial

40
Q

what nerve supplies sensation to lateral aspect of foot?

A

sural nerve (formed from tibial and common fibular)

41
Q

what nerve supplies 1st web space in foot?

A

deep fibular

42
Q

what nerve supplies most of dorsal foot?

A

superficial fibular

43
Q

what nerve supplies medial ankle?

A

saphenous (from femoral)

44
Q

what controls ureteric peristalsis?

A

autonomic action initiated and propagated by ureteric cells which have their own built-in autorhythmicity (like GI tract muscle cells) rather than being directed by sympathetic/parasympathetic nerve fibres

45
Q

what controls bladder contraction?

A

parasympathetic fibres (from S2,3,4 via pelvic splanchnic nerves) stimulate detrusor muscle to contract

46
Q

what controls urethral sphincter/levator ani muscle?

A

sympathetic fibres stimulate internal urethral sphincter muscle to contract
parasympathetic fibres inhibit (relax) the internal urethral sphincter to allow urine to flow through urethra
somatic motor within pudenal nerve stimulate external urethral sphincter to contract
somatic motor fibres within the nerve to levator ani (S3,S4) stimulate levator ani to contract

Renal (34 decks)

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