Presentation on theme: "Essentials of Pathophysiology"— Presentation transcript:
1 Essentials of Pathophysiology Chapter 27 Disorders of the Bladder and Lower Urinary Tract
2 Pre lecture quiz true/false The storage and emptying of urine involves voluntary (somatic nervous system) control only.Stress incontinence is the involuntary loss of urine during coughing, laughing, sneezing, or lifting, which increase intra-abdominal pressure.The average bladder capacity (in ounces) is equal to the age (in years) + 2 of the child.Urinary incontinence is not a common problem in elderly persons.Flaccid bladder dysfunction is a neurogenic disorder of the bladder in which bladder emptying is impaired.In flaccid (hypotonic) neurogenic bladder, volume is large, pressure is low, and contractions are absent. It may result from peripheral nerve damage or spinal cord damage at the S2 to S4 level (Overflow incontinence)
3 Pre lecture quizA neurogenic disorder of bladder function, which is manifested as a failure to store urine, is known as __________ bladder dysfunction.The most common sign of bladder cancer is painless __________.__________ incontinence is characterized by the involuntary loss of urine that results from overfilling of the bladder.The _______________ nervous system promotes bladder emptying.In men, the most important cause of urinary obstruction is external compression of the urethra caused by enlargement of the __________ gland.hematuriaOverflowparasympatheticprostatespastic
4 Micturition Reflex urine produced in kidneys ureters bladder fills Begins when bladder contains mL of urineurineproduced inkidneysuretersbladder fillswith urine
5 Stretch Receptors in the Bladder micturitioncenter instretchbladder fillsstretchspinal reflexponsreceptorswith urinereceptorsstimulatedstimulated
6 Urination Detrusor muscle of bladder contracts to push urine out Abdominal muscles may also be usedInternal sphincter relaxesExternal sphincter relaxesUnconscious in young childrenUnder conscious control in adults
7 QuestionTell whether the following statement is true or false: Abdominal muscles are used during forced urination.
8 Controlling Nerves Parasympathetic- contracts detrusor and inhibits sphincterSympathetic- inhibits detrusor and contracts sphincterAuthor: Please add title.
9 AnswerTrue Passive urination occurs when the bladder’s detrusor muscle contracts, and both internal and external sphincter muscles are relaxed. Abdominal muscles contract in order to force the excretion of urine.
10 Parasympathetic Nerves bladder fillsstretchspinal reflexwith urinereceptorsstimulateddetrusorparasympatheticmuscleM3 receptorsneuronscontractsM3 receptorsinternal sphincterrelaxes and is pulledopen
11 Micturition Center Allows Conscious Control center instretchbladder fillsponsreceptorswith urinestimulateddetrusormusclecontractsConscious Controlexternalinternal sphinctersphincterrelaxes and is pulledrelaxesopen
12 QuestionAll but which of the following stimulates urination?Parasympathetic nervous system neuronsMicturition centerSympathetic nervous systemSpinal reflex
13 AnswerSympathetic nervous systemThe micturition center in the pons and the spinal reflex respond to stretch receptors in the bladder to stimulate urination. The parasympathetic nervous system neurons are stimulated by the spinal reflex to cause urination. Sympathetic NS (fight-or-flight) decreases activity in both the excretory and digestive systems.
14 ScenarioA 63-year-old woman complains of stress incontinence, and her 60-year-old husband complains of difficulty voiding.Question:Why do people of the same age and lifestyle have opposite problems with urination?
15 Male vs Female Urethra Female is urethra 2.5–3.5 cm long Allows urine to pass more freelyMale urethra 16.5–18.5 cm longPasses through prostate
16 QuestionTell whether the following statement is true or false. Benign prostatic hyperplasia (BPH) has no effect on the elimination of urine.
17 AnswerFalse Because the male urethra passes through the prostate gland, if the gland increases in size, the urethra may become compressed or obstructed. This decreases the diameter of the urethra’s lumen, and the ability to urinate is diminished.
18 ScenarioSix months later, the husband develops urgency and incontinence.The doctor explains that it's due to his muscle strength.QuestionWhich muscles is the doctor talking about?How did they cause incontinence?
19 Bladder Wall Hypertrophy The bladder may also pouch outward in diverticuli