Rr-Endocrine-Week3-Lower Urinary Tract + Dysfunction

Front 1

Important Process in Maintaining Continence

Back 1

CNS Inhibition of detrusor, sympathetic stimulation of bladder neck/internal sphincter, and voluntary contraction of external sphincter.

Front 2

What is the role of the CNS in normal bladder function?

Back 2

Voluntary control over micturition
Inhibition of reflex detrusor contraction

Front 3

What is the role of the PNS in normal bladder function?

Back 3

PNS facilitates micturition. Causes detrusor contraction via Ach binding to the muscarinic receptor

Front 4

What is the role of the SNS in normal bladder function?

Back 4

SNS facilitates urine storage. There is inhibition of the detrusor (detrusor relaxation). Can act directly by binding to the beta-3 adrenergic receptor or indirectly by inhibition of PNS. Via alpha adrenergic receptor it can cause contraction of the internal sphincter.

Front 5

What is the role of somatic voluntary control in normal bladder function?

Back 5

Innervation of the external urethral sphincter.

Front 6

Pon Micturition Center

Back 6

In order to urinate the sphincters are relaxed and the detrusor is contracted

Front 7

Micturition Reflex

Back 7

Anatomic reflex between bladder and spinal cord that promotes bladder emptying. Bladder fills with urine causing stretching of bladder wall. Stretch receptors are activated and send signals back to the spinal cord that promote detrusor contraction.

Front 8

How is the Micturition reflex modulated by the CNS

Back 8

-CNS sends inhibitory signals to turn off the micturition reflex in cognitively intact people (babies don't have this)
- Micturition reflex can also be abolished by external sphincter contraction
- When decision to urinate is made, CNS removes inhibitory signals and external sphincter relaxes to allow for micturition reflex to occur.

Front 9

How does the Pontine Micturition Center Work?

Back 9

It coordinates voiding. So you have contraction of the detrusor (PNS) and relaxation of the internal sphincter - inhibition of the alpha adrenergic receptor
- external sphincter relaxation (which is somatically controlled)

Front 10

Damage to the brainstem/pons or spinal cord lesions below the brainstem have the potential to cause?

Back 10

Discoordination. Detrusor contracts simultaneously with the external sphincter -- detrusor-sphincter dyssynergia. Leads to excessively high bladder pressures and trouble emptying the bladder.

Front 11

What are some of the reasons why a person would have difficulty storing urine?

Back 11

This would be an overactive bladder. The person's detrusor muscle would be continually contracting so you could give them an anticholinergic to counteract this (since this would inhibit Ach from binding to the muscarinic receptor).

You could also have relaxation of the detrusor muscle - so it's not contracting and the bladder can become very distended resulting in overflow incontinence

There is also stress incontinence in which the sphincter muscles are weak (as in due to old age or pregnancy). Giving an alpha agonist helps to counteract this because it will result in contraction of the internal sphincter.

Front 12

What are some of the reasons why a person would have difficulty releasing uring?

Back 12

The bladder could be weak and the detrusor isn't contracting. This could be alleviated via a cholinergic agonist.
OR could also be the result of an obstruction - like prostate enlargement, something blocking the urethra, or even a previous incontinence surgery -which can result in scaring - leading to obstruction
OR a hyperactive sphincter - treat with an alpha adrenergic antagonist.

Front 13

Conditions Associated with Urinary Incontinence

Back 13

Overactive Bladder
Stress Urinary Incontinence or even both

Front 14

What are some of the causes of an overactive bladder?

Back 14

-Infection/UTI
- Bladder Irritants like caffeine or diet coke
- Spinal Cord Injury, Stroke, MS
- Uncontrolled Diabetes (glucose and lots of water into bladder)
- Enlarged Prostate (blocks flow of urine - causes bladder to work even harder to push urine out resulting in bladder hyperactivity)
- Lack of estrogen which makes the bladder irritable.
- Obesity
- Pelvic Organ Prolapse - bladder irritation
- Pelvic floor dysfunction resulting in bladder hyperactivity

Front 15

How is over active bladder treated?

Back 15

- Fluid Management
- Kegel Exercises
- Anticholinergics
- Beta 3 Adrenergic Agonist - relaxes detrusor
- Surgery

Front 16

Stress Urinary Incontinence

Back 16

This is incontinence with coughing, sneezing, exercise, heavy lifting (anything that increases intra-abdominal pressure). It is caused by a weakness of the urinary sphincter and support structures of the urethra and bladder neck.

Front 17

What are some of the causes of Stress Urinary Incontinence?

Back 17

Vaginal or Pelvic Trauma
Lack of Estrogen
Neurologic
Radiologic (scarring)
Obesity

Front 18

How is Stress Urinary Incontinence Treated?

Back 18

Kegels
Wt loss
Alpha adrenergic agonist
Surgery

Front 19

How can patients be asymptomatic for urinary retention?

Back 19

They can have it chronically with decreased bladder sensation as in uncontrolled diabetes

Front 20

What is a distinguishing feature of the genital tract immune defenses?

Back 20

That they are kept at a distance from sites of spermatogenesis and oogenesis and can cause sterility this is because inflammation of the gonads can cause sterility. Consequently, the testes and ovaries are considered immunologically privileged.

Front 21

How do hormones greatly influence the activity of leukocytes in the genital tract?

Back 21

The protective capacity of leukocytes in the urogenital tract is dynamic, varying with the stage of menstrual cycle. Women are naturally immunosuppressed when they are pregnant - due to the shift in predominant types of cytokines produced by leukocytes during pregnancy.

Front 22

Failure to shift to a more suppressive immune response during pregnancy is associated with?

Back 22

Spontaneous Abortion

Front 23

The more significant non-self invaders of the female reproductive tract are?

Back 23

Sperm and Fetus

Front 24

Fetus is semi-allogenic

Back 24

Maternally derived genes are synergenic
Paternally derived genes are allogenic

Front 25

What are commensals?

Back 25

Primarily comprise bacterial species and are also known as normal flora. Compete for resources with more virulent organisms. Lower vaginal pH.

Front 26

Which bacteria is of particular significance to the protection of the female urinary tract?

Back 26

Lactobacillus

Front 27

How may commensals be disrupted?

Back 27

Excessive cleaning, frequent douching, spermicides.

Front 28

Toxic Shock Syndrome

Back 28

Characterized by high fever, sunburn-like rash, desquamation, hypotension, and abnormalities in multiple organ systems. Caused by S. aureus. Due to production of superantigen Staphylococcal enterotoxin B (SEB).

Front 29

Defenses of the urinary tract

Back 29

- Physical force of urine flow (flush out bacteria)
- Exfoliation (bladder and ureter cells that come into contact with bacteria shed into the urine)
- Antimicrobial Proteins
- Tamm-Horsfall Protein

Front 30

With the exception of the urethra, innate and adaptive leukocytes are?

Back 30

Absent from the lower urinary tract during times of health

Front 31

Sources of urinary flow obstruction

Back 31

Congenial anomaly
Urethral Stone
Pregnancy

Front 32

Physical force of urine flow and the pressure that accompany it require the lower urinary tract epithelia to be?

Back 32

Elastic

Front 33

Epithelium of the bladder and urethra

Back 33

Transitional. Folds and sliding cells allow for stretching.

Front 34

Primary cause of UTI in adults

Back 34

E. Coli

Front 35

Two classes of Antimicrobial Proteins expressed by urogenital epithelia upon pathogen encounter

Back 35

Defensins and Cathelicidins

Front 36

Tamm-Horsfall Glycoprotein

Back 36

Produced in the kidney loop of Henle, forming a mucoprotein matrix along the renal tubules.

Front 37

Why are women more prone to UTIs?

Back 37

Shorter urethra.

Front 38

How is a UTI diagnosed?

Back 38

Leukocytes in the urine.

Front 39

Most common cause of UTIs in children

Back 39

Enterobacter and Klebsiella

Front 40

Most common nosocomial cause of UTI

Back 40

Pseudomonas aeruginosa

Front 41

What is a UTI

Back 41

Considerable bacteriuria with symptoms of dysuria (burning), urgency, frequency, and occasional suprapubic pain.

Front 42

Leukocyte Esterace

Back 42

- Detects Pyruria (WBC in urine)
- Diagnosis of Pyruria:
due to pregnancy, vaginal infection, inflammation from bladder or kidneys, tumor, stones
High Specificity
Sensitivity

Front 43

Nitrites

Back 43

Produced by action of bacteria on dietary nitrates through nitrate reductase. Very low false pos rate for UTI
High Specificity
Low Sensitivity

Front 44

False Negatives Associated with Nitrites

Back 44

Not all bacteria have the enzyme nitrate reductase
Nitrate to Nitrite conversion takes 4-6 hours
First AM void is best

Front 45

Sterile pyuria is caused by?

Back 45

TB

Front 46

Blood not associated with a UTI has to be?

Back 46

worked-up

Front 47

What do you treat an uncomplicated UTI with?

Back 47

Bactrim

Front 48

Recurrent UTIs

Back 48

Implies reinfection from outside the urinary tract or bacterial persistence

Front 49

When do you use Cipro for a UTI?

Back 49

For a more complicated UTI

Front 50

Non-antibiotic Prophylaxis of UTI

Back 50

- Methenamine Salts (converted to formaldehyde and ammonia in acidic urine)
- Cranberry Juice
- Ascorbic acid (alkalinizes the urine)

Front 51

Midstream Urine

Back 51

Wipe urethra. Pee a little. Then catch midstream. Then pee out the rest.

Front 52

Complicated UTIs

Back 52

Due to DM, abnormal anatomy, surgery, stones, spinal cord injury, pregnant patients.

These patients are more likely to develop renal damage, bacteremia, sepsis, increased mortality

Front 53

Asymptomatic Bacteriuria

Back 53

Treated in children with vesicouretral reflux and in pregnant women. Should not be treated in most circumstances.

Front 54

Prophylaxis Management

Back 54

Prevention of UTI from outside contamination (due to sex)

Front 55

Suppression Management

Back 55

Prevention of UTI from bacterial persistence (due to kidney stone)

Front 56

Majority of UTIs derive from?

Back 56

Ascending Infections

Front 57

UTI warning signs

Back 57

>= 3 UTIs per yr
Complicated UTIs
History of childhood UTIs or pyelonephritis
LT sided pyelonephritis during pregnancy (anatomy anomaly)
Blood