Lecture 15: Bladder function Flashcards Preview

Phase 2: Reproduction, Nephrology and Urology > Lecture 15: Bladder function > Flashcards

Flashcards in Lecture 15: Bladder function Deck (38)
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1
Q

Name these parts of the urinary bladder

A
2
Q

Distal sphincter mechanism is composed of which structures?

A
  • Urethral smooth muscle
  • Intrinsic rhabdosphincter
  • Peri-urethral musculature
3
Q

Which muscle undergoes relaxation during the storage phase of micturition?

A

Detrusor

4
Q

What is the normal capacity of the urinary bladder?

A

400-500mL

5
Q

What are the layers of the detrusor muscle

A

Longitudinal - Innermost layer

Circular - middle layer

Longitudinal - outermost layer

6
Q

Name these layers of the urinary bladder

A
7
Q

The vasculature of the bladder is primarily derived from the ___ vessels.

A

The vasculature of the bladder is primarily derived from the internal iliac vessels.

8
Q

Describe the blood supply to the urinary bladder

A

Arterial supply is via the superior vesical branch of the internal iliac artery.

In males, this is supplemented by the inferior vesical artery, and in females by the vaginal arteries.

In both sexes, the obturator and inferior gluteal arteries may also contribute small branches.

9
Q

Describe the venous drainage of the urinary bladder

A

Vesical venous plexus, which empties into the internal iliac veins.

10
Q

Describe the parasympathetic innervation of the bladder

A

P for Pee

Parasympathetic fibres are for peeing.

Parasympathetic fibres are derived from pelvic splanchnic nerves (S2-4)

Motor to detrusor and inhibitory to internal sphincter

11
Q

Describe the sympathetic innervation of the urinary bladder

A

S- for storage

Sympathetic fibres are for storaging- bladder filling

Derived from T11-L2

Relaxes detrusor and contracts internal sphincter

12
Q

The ____ fibres are for peeing?

A) Sympathetic

B) Parasympathetic

A

B) Parasympathetic

P for Peeing

13
Q

The ____ fibres are for bladder storage?

A) Sympathetic

B) Parasympathetic

A

A) Sympathetic

S for Storage

14
Q

Name the sphincters for the urinary bladder

A
  1. Internal urethral sphincter
  2. External urethral sphincter
15
Q

What is the epithelium of the urinary bladder

A

Transitional

16
Q

What happens to the detrusor muscle during micturition

A

The detrusor muscle is able to contract during micturition to expel the urine.

17
Q

Describe the internal urethral sphincter

A
  • Male – consists of circular smooth fibres, which are under autonomic control.
  • Females – functional sphincter (i.e. no sphincteric muscle present).
18
Q

Describe the external urethral sphincter

A
  • It is skeletal muscle, and under voluntary control.
  • Supplied by the pudental nerve (somatic motor fibre)
19
Q

Parasympathetic innervates the internal urethral sphincter to ____ and causes the _____ of the detrusor muscle. Overall, causing ____.

A

A) Relax

B) Contracts

C) Urination

20
Q

Sympathetic innervates the internal urethral sphincter to ____ and causes the _____ of the detrusor muscle. Overall, causing ____.

A

A) Contract

B) Relaxation

C) Bladder storage

21
Q

Sympathetic fibres that innervate the urinary bladder is the ____ nerve, that comes from the _____ spinal cord level.

A

A) Hypogastric

B) T11 - L2

22
Q

What are the 2 main populations of receptors in the urinary bladder

A

Cholinergic (muscarinic) and adrenergic

23
Q

Describe the Cholinergic (muscarinic) receptors of the urinary bladder

A
  • Muscarinic subtypes M1-M3 in bladder smooth muscle
  • M2 80% population, but M3 functionally MOST important – mediates bladder contraction
24
Q

Describe the adrenergic receptors of the urinary bladder

A

Adrenergic subtypes β1 and β2

25
Q

Which muscarinic receptor of the bladder cause the bladder contraction.

A

M3

26
Q

What are the 3 layers of the wall of the bladder body

A

adventitia, smooth muscle, and urothelium.

27
Q

Whcih adrenergic receptor of the bladder mediated detrusor relaxation (weakening) during storage phase

A

β-3 adrenoceptor

28
Q

What are the 3 types of neurological lesions that can affect bladder function

A
  1. Suprasacral lesions - lesion at the T11 level.
  2. Infrasacral lesions - L1 level.
  3. Suprapontine- lesion above the pons
29
Q

Describe suprapontine lesions

A

Overactive bladder with intact sphincter behaviour

Detrusor is contracting too much. Gives you symptoms of urgency. Kidney is safe as when they want to pee they can.

30
Q

What are the common causes of suprapontine lesions

A
  1. Dementia
  2. Parkinson’s disease
  3. Relative dopamine deficiency
31
Q

Describe suprasacral lesions

A

When the pee they cannot completely empty the bladder. Build up of pressure that eventually goes into the kidneys

32
Q

What is the most common cause of suprasacral lesions

A

Multiple sclerosis (MS)

33
Q

Describe infrasacral lesions

A

Result in detrusor underactivity and voiding dysfunction

Present with interrupted stream and a feeling of incomplete emptying

34
Q

What are the common causes of infrasacral lesions

A

Sacral cord injury

Lumbar disc herniation

Cauda equina

35
Q

Define Obstructive nephropathy

A

Damage to renal parenchyma resulting from obstruction to flow of urine

36
Q

Describe high pressure chronic retention (HPCR)

A
  • Tense painless bladder
  • Maintenance of micturition
  • Renal impairment
  • Always at least 800mls of urine left in the bladder- even after emptying
37
Q

Define nocturnal enuresis

A

Involuntary urination that happens at night while sleeping

38
Q

Describe the 3 stage theory of prostatism

A
  1. Prostatic hypertrophy causes increasing outlet resistance causes bladder muscle hypertrophy- trabeculation
  2. As this progresses sacculation and diverticulum formation occurs and ureters dilate
  3. Bladder becomes decompensated – flaccid, large and over distended NB overflow incontinence