Card Set Information
Mountain State University Physician Assistant class of 2014
explain the mechanism of low pressure urine storage in the bladder
in order to maintain continence, pressure in the bladder must be lower than pressure in the urethra
list three classes of autonomic drugs and their effect on bladder function
cholinergic drugs stimulate PSNS that cause detrusor contraction
B2 blockers block receptors that cause detrusor relaxation
CCBs interfere with Ca to contract detrusor
A1 agonist/blocker produce/block interal sphincter contraction
Muscle relaxants - decrease external sphincter tone
describe three urodynamic studies that can be used to assess bladder function
uroflowmetry-flow rate during urination
cystometry-bladder pressure during filling and voiding
urethral pressure profile-intraluminal pressure changes in the urethra during rest
sphincter electromyography-electric activity of voluntary muscle
what does the parasympathetic nervous system do in the bladder?
promotes bladder emptying, produces contraction of the smooth muscle of the bladder wall and relaxation of the interal sphicter
what does the sympathetic nervous system do in the bladder?
promotes bladder filling
produces relaxation of the smooth muscle of the bladder and contraction of the internal sphincter
what does the somatic nervous system do in the bladder?
the striated muscles of the external sphincter and pelvic floor provide voluntary control of urination and maintenance of continence
where does the immediate coordination of the normal micturition reflex occur?
in the micturition center in the pons, facilitated by descending input from the forebrain and ascending input from the reflex centers in the spinal cord
causes of urinary tract obstruction?
STDs and tumors
compensatory changes in urinary tract obstruction?
compensatory stage - hypertrophy of bladder,decreased ability to control spasm,
decompensatory-frequency, hesitancy, need to strain, weak small stream, incomplete emptying
differentiate lesions that produce storage dysfunction associated with spastic bladder from emptying dysfunction with flaccid bladder in terms of lesion level and effects
spasm-lesion above the micturition reflex center in sacral cord,
flaccid - injury to micturition center in sacral cord
describe methods used in the treatment of neurogenic bladder
catheterization,bladder retraining, Rx manipulation of contractile
differentiate stress,overactive/urge,and overflow incontinence
stress - coughing, any increase in intra-abdominal pressure
overactive/urge - urgency and frequency with hyperactivity of detrusor muscle
overflow - involuntary loss when bladder pressure exceeds urethral pressure in the abscense of detrusor activity
describe treatment of incontinence
exercises to strengthen muscles
indwelling or self catheterization
treatable causes of incontinence in elderly
Atrophic urethrits and vaginitis
Excessive urine output
what are the signs of bladder cancer?
what are the diagnostic measures for bladder cancer
CT / MRI