Urinary3- Micturition Disorders

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Mawad
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311078
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Urinary3- Micturition Disorders
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2015-12-06 23:25:05
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vetmed urinary3
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vetmed urinary3
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  1. Somatic innervation of the bladder.
    pudendal n.
  2. Sympathetic innervation of the bladder.
    hypogastric n.
  3. Parasympathetic innervation of the bladder.
    pelvic nn.
  4. Nicotinic cholinergic receptors stimulate ______________.
    skeletal muscle contraction in the urethra
  5. Beta receptors trigger ___________.
    detrusor m. relaxation
  6. Alpha receptors trigger ___________.
    urethral sphincter contraction
  7. Muscarinic cholinergic trigger ____________.
    detrusor muscle contraction
  8. Factors important for continence. (5)
    smooth muscles of urethra, urethral mucosa, vasculature, connective tissue, pelvic floor
  9. What types of receptors play a role in the filling/storage phase? (3)
    nicotinic cholinergic, beta-adrenergic, alpha-adrenergic
  10. What types of receptors play a role in the voiding phase of micturition? (1)
    muscarinic cholinergic
  11. What nerve and component of the ANS play a role in voiding?
    pelvic nerve- parasympathetic NS
  12. What nerve and component of the ANS play a role in filling/storage?
    hypogastric nerve- sympathetic NS
  13. What nerve plays a role in "guarding reflex"?
    pudendal n.
  14. Describe the neurologic process that leads to voiding.
    pelvic n. stimulates muscarinic cholinergic receptors--> detrusor m. contraction===simultaneously inhibitory signals sent to sympathetic reflexes--> urethral relaxation------> voiding
  15. Describe the neurologic process that leads to guarding reflex.
    [in response to rapid increase in abdominal pressure; sneeze/cough/etc.] pudendal nerve stimulates nicotinic cholinergic receptors--> urethral skeletal m. contraction--> guarding reflex
  16. Describe the neurologic process that sustains the storage/filling phase.
    Hypogastric nerve stimulates alpha and beta adrenergic receptors--> [alpha] urethral sphincter contraction + [beta] detrusor muscle relaxation-------> filling/storage
  17. The pelvic floor is required for the __________.
    guarding reflex
  18. How does a pelvic bladder affect continence?
    no/decreased pelvic urethra--> incontinence; abdominal pressure on the pelvic urethra prevents urine from entering the urethra
  19. What is an important aspect of the PE of an animal suspected of a micturition disorder?
    observing the patient urinating
  20. Disorders of urine storage. (4)
    urethral sphincter mechanism incompetence (USMI), ectopic ureters, overactive bladder (detrusor hyperreflexia), idiopathic incontinence (FeLV/FIV related)
  21. Causes of urinary incontinence. (3)
    sphincter mechanism incompetence, ectopic ureters, detrusor hyperreflexia
  22. Low ______ leads to decreased urethral muscle tone, urethral vascular atrophy, and glandular atrophy; this contributes to ________.
    estrogen; USMI [more complex than just low estrogen]
  23. Risk factors for USMI. (6)
    breed, body weight (>20kg), age at neuter, tail docking, recessed vulva, bladder position
  24. Cystometrogram allows you to evaluate... (2)
    detrusor function, filling and emptying phase
  25. Urethral pressure profile allows you to evaluate... (2)
    resting urethral pressure, stress UPP
  26. Describe medical treatment of USMI. (2 classes, 5 drugs)
    • Alpha1a agonists- phenylpropanolamine, pseudoephedrine
    • Estrogen compounds- DES, Premarin, Estriol
  27. What are the side effects of estrogen treatment for USMI? (4)
    attract males, mammary neoplasia, vulvar swelling, myelosuppression (?)
  28. What are the side effects of alpha agonist Ephedrine treatment for USMI? (4)
    hypertension, hyperactivity/aggression, decreased appetite, panting
  29. What is the most commonly used therapy for USMI?
    alpha-agonist PPA (phenylpropanolamine)
  30. What are the side effects of alpha agonist PPA treatment for USMI? (5)
    hypertension, hyperactivity, changes in appetite, panting, sleep disturbances
  31. What is a downside to use of PPA to treat USMI?
    may lose effect in some dogs with time
  32. [Developing drug]  How do GnRH analogs treat USMI?
    replace loss of negative feedback, decrease LH and FSH
  33. [Developing drug] How are SSRI's thought to work?
    turn up the glutamate activation of motor neurons to the urethral striated muscle only during filling
  34. 4 surgical treatments for USMI (not usually used)?
    colposuspension, injectable bulking agents, sling procedures, artificial urethral sphincter
  35. Often, male dogs that are diagnosed with USMI actually have ________.
    DUD
  36. History that usually accompanies ectopic ureters? (3)
    incontinent since birth (owners may think it's house-training problems), incontinence may be intermittent or constant, breeds [husky, lab, golden, newfoundland, westies, soft-coated wheaten terrier]
  37. How do you definitively diagnose ectopic ureters?
    cystoscopy
  38. Low compliance of the detrusor and contraction of the detrusor muscle during the filling phase.
    detrusor hyperreflexia (instability)
  39. What is the therapy for detrusor hyperreflexia? (1 class, 3 drugs)
    anticholinergic drugs- oxybutynin, imipramine, dicyclomine
  40. FeLV/FIV associated incontinence is __________ in nature, and is thought to be associated with the _________ that can accompany these diseases.
    idiopathic; myelopathy
  41. 4 disorders of voiding.
    reflex dyssnergia (DUD), bladder/detrusor atony, automatic (UMN) bladder, autonomous (LMN) bladder
  42. Causes of disorders of voiding. (5)
    uroliths, neoplasia, functional, anatomic deformity/ stricture, extraurinary (masses outside the urinary system)
  43. Clinical signs of disorders of voiding. (4)
    straining to urinate, pain on urination, poor urine stream, inability to empty the bladder
  44. Incontinence in the male dog associated with a weak urethra. (3)
    USMI, pollakiuria, LMN bladder
  45. Incontinence in the male dog associated with overflow. (4)
    DUD***, bladder/detrusor atony, UMN bladder, other obstruction
  46. USMI is less common on male dogs because of the __________.
    prostatic plateau
  47. In a male dog, you must rule out ________ before you diagnose USMI.
    DUD
  48. In order to urinate, signals must travel from the ________ to the __________ first; then, signals going to other way cause ___________ and inhibit __________.
    bladder; brain [tell it it's full]; bladder contraction; adrenergic contraction of the urethra
  49. A local __________ must be intact to tell the urethra to relax as the bladder contracts.
    reflex arc
  50. To urinate, the _________ must be able to relax.
    urethra
  51. Poor relaxation of the urethral sphincter during bladder contraction.
    DUD- detrusor-urethral dyssynergia
  52. Lesions in __(2)__ are associated with DUD.
    reticulospinal tract or caudal mesenteric ganglion
  53. Describe urine flow of a dog with DUD.
    stream starts normal then it slows to a drip or becomes very narrow
  54. How do you diagnose DUD?
    >0.5mL/kg residual urine in the bladder after voiding
  55. What dogs usually present with DUD?
    young to middle-aged large breed male dogs
  56. What will you find on PE of a DUD patient? (2)
    large bladder, normal/enlarged prostate
  57. [Differentials] straining to urinate, large bladder after urination. (4)
    mechanical obstruction- calculi, stricture, neoplasia; functional obstruction- DUD
  58. [Differentials] straining to urinate, small bladder after urination. (5)
    inflammation- UTI, calculi, polyploid cystitis, urethritis, neoplasia
  59. Treatment goals when treating DUD. (4)
    reduce smooth and skeletal m. sphincter tone, address anxiety (if present), prevent bladder over-distension, teach owner to catheterize dog
  60. Surgical neuter of intact male dogs may resolve signs associated with ______.
    DUD
  61. Medical treatment options for DUD. (3 classes, 10 drugs)
    alpha-1 antagonists- prazosin, tamsulosin, phenoxybenzamine; skeletal muscle relaxants- diazepam, baclofen, methocarbamol, dantrolene; detrusor agonists- bethanachol, cisapride, metaoclopromide
  62. How is acepromazine used as part of the treatment plan for DUD? (2)
    smooth muscle relaxant, anti-anxiety
  63. Anti-anxiety medications used as adjunct treatment for DUD. (3)
    acepromazine, trazadone, fluoxitine
  64. If medical treatment fails for DUD, what surgical methods have been used? (3)
    urethral stenting, cystostomy tube, botulinum toxin A (controversial)
  65. Prognosis for DUD patients is dependent upon... (4)
    degree of bladder distention, degree of response to therapy, risks of hypotension, owner willingness to catheterize
  66. Functional obstruction dysautonomia has a(n) ________ onset; may present with __(3)__.
    acute; constipation, dysuria, and urine dribbling
  67. Detrusor atony is secondary to ___________ and separation of ________ in the _________.
    over-distension; tight junctions; detrusor muscle
  68. Improve bladder emptying associated with dysautonomia with __________ [drug].
    Bethanechol (parasympathomimmetic)
  69. What is the therapy for detrusor atony? (3)
    remove obstruction, u-cath for up to 2 weeks to keep bladder empty and to allow tight junctions to re-establish, Bethanechol (stimulate muscarinic receptors)
  70. Automatic UMN bladder is caused by CNS lesions cranial to _______.
    S1-S2
  71. Describe the pathophys of UMN bladder.
    loss of UMN inhibition of sphincter--> cannot void on own--> spontaneous voiding when high bladder pressures reached
  72. Autonomous LMN bladder is caused by a spinal cord lesion at ________ and a disruption of _________.
    S1-S2; local reflex arc
  73. Animals with UMN bladder, it is ________ to express the bladder; animals with LMN bladder, it is ________ to express the bladder.
    difficult; easy
  74. Describe ectopic ureters.
    ureters enter serosa at trigone (normal location) but then travel caudally through the submucosa to open in the bladder neck, urethra, or even vestibule
  75. Detrusor hyperreflexia is treated with _________ to __________.
    anti-muscarinics; reduce bladder contraction
  76. If you use __________ to improve bladder contractility in a DUD dog, you MUST also be using a(n) __________ because...
    Bethanacol (parasympathomimetic); alpha-antagonist; you don't want the bladder contracting against a closed sphincter.

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