Pathophys 2 Alterations In Urine Elimination

Front 1

List the layers of the bladder starting with the outermost layer ->in

Back 1

serosa
detrusor muscle (thickest)
submucosa
mucosa

Front 2

T/F

the urethra is formed by the detrusor muscle

Back 2

F

entire urethra in women - is detrusor
men- only posterior urethra is detrusor

Front 3

which is not under control of the sympathetic nervous system?

a) trigone
b) ampulla
c) detrusor
d) all are under symp control

Back 3

F

detrusor (and xternal sphincter) are parasymp

Front 4

which is not true about the parasymp nervous system?

a) includes T11-L1
b) promotes urination
c) controls xternal shpinter
d) actions coordinated by brain stem

Back 4

T11-L1 is sympathetic

Front 5

______ area is the sympathetic bladder reflex center

______ area is the parasymp bladder reflex center

Back 5

T11-L1 - symp

S2-S4 - parasymp

Front 6

T/F

Men can more easily control when they urinate

Back 6

T

bc only post urethra is detrusor muscle

Front 7

T/F

brain stem allows for conscious control of urination by inhibiting micturition center

Back 7

F

brain stem- coordinates xtrnl sphinter and detrusor muscle activity

cortical/subcortical centers inhibit micturition and allow for conscious control (cerebral cortex)

Front 8

_____ml creates sensation of fullness

Back 8

150-300ml

Front 9

upon sensation of fullness signals are transmitted to ______________

Back 9

spinal cord (symp)
cerebral cortex (parasymp-conscious control)

Front 10

to maintain continence what must be true

a) bladder must be a hi prssr syst
b) bladder must be at low prssr
c) bladder pressure must be higher than ureteral pressure
d) a,c
e) b,c

Back 10

bladder must be low pressure

(bladder pressure must be lower than ureteral pressure)

Front 11

describe the mechanics of micturition

Back 11

-detrusor contracts to shut down ureteral orifice
-bladder neck becomes wider/shorter
-internal sphincter opens

Front 12

list the causes of urinary retention

Back 12

urethral obstruction (scar tissue, stone, prostate enlargment)
impaired innervation
drugs

Front 13

which is not included in the early stage pathologies of urine retention

a) hypertrophy of detrusor
b) frequent urination
c) incontinence
d) hi pressure storage syst

Back 13

hi pressure storage - compensatory stage -> diverticula/stasis/infection

Front 14

which of the following is included in the compensatory stage of urinary retention

a) increased residual volume
b) short periods of detrusor contractions
c) diverticula
d) All

Back 14

diverticula = compensatory

rest are decomensated

Front 15

list the pathalogical changes that occur when urinary retention reaches a decompensated stage

Back 15

short periods of contraction of detrusor ->increased residual vol- hesitancy- frequent urination

weak contraction -> small/weak stream, need to strain

overflow incontinence, acute retention

Front 16

list pathological changes that occur during the early stages of urinary retention

Back 16

hypertrophy of detrusor
hypersensitivity of detrusor
frequent urination/incontinence

Front 17

list the compensatory pathological changes that occur with urinary retention

Back 17

hypertrophy of detrusor -> frqnt urination

hi prssure storage -> diverticula -> stasis/infection

hypertrophy of interureteric ridge -> back pressure on ureters -> dilated ureters

Front 18

T/F
back pressure on the ureters occurs during the decompensated phase of urinary retention

Back 18

F

compensatory phase

Front 19

list the types of neurogenic bladder disorders

Back 19

spastic bladder dysfnctn
flaccid bladder dys
non-relaxing xtrnl sphincter

Front 20

which belongs to the decompensated phase of urinary retention

a) short period of contraction of detrusor
b) weak contraction causing strain/weak stream
c) overflow incontinence
d) acute retention
e) all

Back 20

all

Front 21

T/F

Injury to S1 of the spinal cord will likely cause spastic bladder dysfunction

Back 21

true - caused by neurologic impairment above the sacral reflex center -> automatic bladder

Front 22

a woman in a car accident severed her spinal cord at S3- which disorder is most likely to occur

a) spastic bladder dysfunction
b) urinary incontinence
c) flaccid bladder dysfunction
d) Non-relaxing external sphincter

Back 22

flaccid bladder dysfunction - caused by injury to sacral micturition center (or diabetic neuropathy)

(spastic bladder- caused by injury above sacral micturition center)

Front 23

an anxiety attack is most likely to cause


a) spastic bladder dysfunction
b) urinary retention
c) flaccid bladder dysfunction
d) Non-relaxing external sphincter

Back 23

non-relaxing external sphincter

Front 24

which is true about spastic bladder dysfunction

a) causes inability to perceive bladder fullness
b) related to depression or anxiety
c) efficient emptying of bladder achieved
d) all or none

Back 24

none

those related to flaccid bladder dysfunction and non relaxing external sphincter

Front 25

after surviving an accident the px can no longer control their bladder- urination is automatic- what is the likely diagnosis

Back 25

spastic bladder dysfnction causing uninhibited neurogenic bladder
px injured above sacral center

Front 26

T/F

Atony of the detrusor muscle is seen in the acute phase of spastic bladder syndrome

Back 26

F- atonic bladder

(atony of detrusor occurs during flaccid bladder dysfunction causing loss of fullness perception

Front 27

T/F with flaccid bladder dysfunction it is still possible to efficiently empty the bladder

Back 27

T- achieved by using intra-abdominal or suprapubic prssr

Front 28

loss of voluntary urination is a manifestation of

a) Spastic Bladder Dys
b) Flaccid Bladder Dys
c) Urinary Retention
d) Non-relaxing xteranl sphincter

Back 28

Flaccid Bladder dys- loss of fullness perception
Spastic Bladder dys- automatic bladder

Front 29

what is the definition of urinary incontinence

Back 29

involuntary loss of urine that is sufficient to be a problem

Front 30

list the types of urinary incontinence

Back 30

stress incontinence (most common)
Urge incontinence
overflow incontinence

Front 31

what is the normal urethrovesical angle?
loss of this angle will cause _____

Back 31

90-100 deg

Stress Incontinence (also caused by internal sphincter weakness)

Front 32

T/F
activities that increase intra-ab pressure can cause urge incontinence

Back 32

F-
urge - associated with strong desire to void

stress- due to increase intra-ab pressure

Front 33

list the causes of stress incontinence

Back 33

loss of urethrovesical angle

internal sphincter weakness

Front 34

which is not a cause or urge incontinence

a) Arthritis
b) MS
c) Obstruction
d) UTI

Back 34

obstruction causes overflow incontinence

Front 35

what causes overflow incontinence

Back 35

obstruction (ex enlarged prostate)
fecal impaction
damage to nervous system