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Bioscience II > Urinary Function and Pathology > Flashcards

Urinary Function and Pathology Flashcards

1
Q

What does the outer region of the kidney contain?

A

the glomeruli, convoluted tubules of the nephron and blood vessels

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2
Q

What does the inner region of the kidney contain?

A

renal pyramids

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3
Q

what drains the upper and lower halves of the kidney?

A

the renal pelvis that has a wide funnel shaped structure at the top of each ureter that is made of calyces

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4
Q

What is the lumen of each ureter lined with?

A

transitional epithelium

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5
Q

Describe transitional epithelium

A

it is pseudo stratified tissue with cells that are cuboid in a relaxed state and squamous in a distended state; only found in the ureter and bladder

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6
Q

What happens as urine collects in the renal pelvis?

A

pressure in the pelvis then increases causing a peristaltic contraction to initiate electrical pacemakers and force urine to the bladder
PNS stimulation increases the contractions
SNS stimulation decreases the contractions

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7
Q

Why are the ureters placed at an angle in the bladder wall?

A

this increases the pressure to compress the ureter and prevent back flow (reflux) of urine up the ureter

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8
Q

What are the 4 layers of the bladder?

A
  • outer serosal layer
  • smooth muscle layer (detrusor)
  • submucosal layer of loose CT
  • inner mucosal lining of
  • transitional epithelial tissue (urothelium)
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9
Q

What type of tissue makes up the urothelium?

A

stratified epithelium that is impermeable to water and salt

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10
Q

what is the muscle of micturition?

A

the detrusor muscle

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11
Q

What is the internal urinary sphincter?

A

portion of the detrusor muscle that continues downward and makes up the urethra of females and posterior urethra of males

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12
Q

What is the external urinary sphincter made up of?

A

skeletal muscle that is under voluntary control

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13
Q

What is located on the posterior wall of the bladder just above the neck and is small triangular area?

A

the trigone

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14
Q

What is the significance of females having a small bladder?

A

It means there is less resistance to the flow of urine which is why females are more prone to incontinence than males

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15
Q

neural control of the bladder

A

excitatory input causes the bladder to empty (parasympathetic)
bladder smooth muscle relaxes via sympathetic input

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16
Q

Where are the reflex centers for micturition located?

A

in the sacral segments S1-S4 and the thoracolumbar segments

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17
Q

What nerve innervates the bladder neck and trigone?

A

the hypogastric

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18
Q

What signals are needed for the bladder to fill?

A

cortical input that is inhibitory via the hypogastic nerve to promote relaxation of the detrusor and maintain continence

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19
Q

What signals are needed for the bladder to empty?

A

the cortex gives input to remove inhibition and have stimulation of the PNS neurons for contraction of the detrusor via pelvic nerves

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20
Q

What is the role of cortical and subcortical centers?

A

they keep the micturition reflex inhibited except when it is necessary and appropriate to urinate

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21
Q

What does high bladder tone mean?

A

large pressure increase with little volume added

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22
Q

What does low bladder tone mean?

A

small pressure increase with more volume added

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23
Q

When does the first sensation to go pee occur?

A

at about 150 ml

sensation of fullness in 400-500ml range

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24
Q

how is the micturition reflex generated?

A

by stretch of the bladder wall

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25
Q

What is the effect of cholinergic drugs?

A

they increase tone and contraction by stimulating parasympathetic receptors

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26
Q

What is the effect of B2 adrenergic blocking drugs?

A

they inhibit relaxation during filling by blocking B2 receptors

27
Q

What do B2 receptors do?

A

produce detrusor relaxation

28
Q

What is the effect of anticholinergic drugs?

A

they will decrease tone by blocking muscarinic receptors therefore you will not have contraction and will not pee

29
Q

What is the effect of Ca2+ channel blockers

A

they will decrease tone by limiting the amount of Ca2+ needed for smooth muscle contraction

30
Q

what is the effect of a1 adrenergic agonists?

A

they increase tone by activating the a1 receptors to produce contraction of smooth muscle

31
Q

what is the effect of a1 adrenergic blockers?

A

they decrease tone by blocking contraction of the smooth muscle of the internal sphincter

32
Q

what is the effect of skeletal muscle relaxants?

A

they cause relaxation of the external urinary sphincter which promotes urination

33
Q

What is the primary NT active in urination?

A

ACh

34
Q

What type of receptors does the detrusor muscle have?

A

beta-2 receptors

35
Q

What type of receptors does the trigone have?

A

alpha-1 receptors

36
Q

What is a spastic bladder?

A

inability to store urine
cause by reflex bladder spasms and a decrease in bladder volume that is necessary to trigger urination reflex
-uninhibited contraction of the detrusor muscle

37
Q

What type of lesion can cause spastic bladder?

A

lesions ABOVE the level of the sacral micturition reflexes

-tumor, stroke, MS, SCI

38
Q

What is a flaccid bladder?

A

-inability to empty the bladder
the bladder becomes
-overstretched and weakened
-voluntary peeing doesn’t happen

39
Q

What can cause a flaccid bladder?

A

injury BELOW the sacral reflex centers

trauma, tumors, spina bifida, peripheral neuropathy, diabetes

40
Q

What are the 4 types of incontinence?

A

urgency
stress
mixed
overflow

41
Q

what is urgency incontinence?

A

involuntary leakage accompanied by or immediately preceded by urgency -
sudden, urgent bladder contraction !
- most common in older adults!

42
Q

What is stress incontinence?

A

involuntary leakage on effort or exertion, or on sneezing or coughing!

  • often related to compression of bladder!
  • most common in women under 60, men who have had prostate surgery!
43
Q

What is mixed incontinence?

A

involuntary leakage associated with urgency and also with effort, exertion,
sneezing, and coughing!
- combination of urge and stress!
- most common in older women

44
Q

What is overflow incontinence?

A

bladder too full because it cannot be emptied!
- leakage then occurs in the absence of detrusor activity!
- rarer - results form bladder obstruction or injury!
• could be the result of prostate enlargement in men!
• severe constipation can be a cause as well!

45
Q

What is functional incontinence?

A

just can’t get where you need to be to urinate!
• could be mobility related, for example, can’t find a bathroom, can’t manipulate
clothing secondary to visual, other sensory, or fine motor impairments, diuretics

46
Q

What is nocturnal enuresis?

A

any involuntary loss of urine during sleep

47
Q

What is the 2nd most common type of bacterial infection?

A

UTI

48
Q

What are the risk factors for UTIs?

A

presence of obstruction, reflux, or stasis!
• sexually active women!
• post-menopausal women!
• men with prostate disease!
• anyone with urinary catheter!
• occur more commonly in women with diabetes than women without!

49
Q

What can cause a UTI?

A

80% of UTI caused by Escherichia coli!
• 5-15% caused by Staphylcoccus saprophytic us!
•

50
Q

What mechanisms does our body have to protect us from a UTI?

A

urine in kidneys and bladder usually sterile!
• washout phenomenon - urine flowing out of urethra flushes out any bacteria!
• bladder lined with mucin - a glycoprotein, provides a protective barrier!
“13
April 2014
- post-menopausal women produce less, increased risk bacteria may adhere,
colonize bladder
IgA present in urinary tract along with phagocytic cells in small numbers!
• normal flora in women prevent growth of other bacteria, male prostatic fluid protects
urethra from colonization

51
Q

What is pyuria?

A

presence of leukocytes in urine

found in an urinalysis for diagnosis of UTIs

52
Q

What is antibiotic commonly used for treatment of UTIs?

A

trimthoprim-sulfamethoxazole
(TMP/SMX)
better known as Bactrim

53
Q

What is pyelonephritis?

A

an ascending infection of the urinary tract that affects the parenchyma and pelvis of the kidney
the progression of it is more common in children

54
Q

What are the symptoms of pyelonephritis?

A

more severe, typical infection - fever, chills, nausea, vomiting, abdominal pain,
leukocytosis
- pain with palpation over CVA - (Murphy’s sign)
- diaphragm can become irritated, referring pain to ispilateral shoulder or low back

55
Q

What is the chronic form of pyelonephritis?

A

chronic inflammatory diesease

56
Q

Why is there a high prevalence of UTIs in females?

A

the urethra is much shorter therefore there is less resistance and a higher likelihood of incontinence

57
Q

How does pregnancy contribute to the risk of UTIs?

A

pregnancy causes dilation of the upper urinary system, displacement of the bladder and a decrease in peristaltic contractions of the ureters

58
Q

prevalence of UTIs in children

A

7% in females, 1% in males
risk is highest in premature infants
average age of diagnosis is younger than 6
more frequent during toilet training

59
Q

signs and symptoms of UTIs in children

A

differ from adult symptoms:
fever, apneic episodes, poor skin
perfusion, diarrhea, vomiting, lethargy, irritability in neonates

abdominal pain, vomiting, diarrhea, abnormal voiding patterns in toddlers

more typical symptoms in older children frequency, urgency, suprapubic discomfort, fever,
enuresis

60
Q

What kind of bladder cancer makes up 90% of the cases?

A

transitional cell carcinoma which is 4x more common in men and 2x as common in whites

61
Q

etiology of bladder cancer

A

unknown - may be related to carcinogens excreted in urine, stored in the bladder
- chemical exposure in industry (painters, metalworkers, truck drivers - diesel
exhaust)
- strong link to smoking, 65-75% of cases associated with smoking
- chronic bladder infections, bladder stones may contribute to risk (squamous cell)

62
Q

signs and symptoms of bladder cancer

A

painless hematuria most common presenting sign, gross hematuria 80-90% of the
time
• hematuria may be intermittent which can delay diagnosis, degree of hematuria not
related to volume or stage of tumor.

63
Q

what is the preferred method for treatment of bladder cancer?

A

surgical resection of the tumor via cystoscope

Bioscience II (10 decks)

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