The flashcards below were created by user
Mawad
on FreezingBlue Flashcards.
-
Somatic innervation of the bladder.
pudendal n.
-
Sympathetic innervation of the bladder.
hypogastric n.
-
Parasympathetic innervation of the bladder.
pelvic nn.
-
Nicotinic cholinergic receptors stimulate ______________.
skeletal muscle contraction in the urethra
-
Beta receptors trigger ___________.
detrusor m. relaxation
-
Alpha receptors trigger ___________.
urethral sphincter contraction
-
Muscarinic cholinergic trigger ____________.
detrusor muscle contraction
-
Factors important for continence. (5)
smooth muscles of urethra, urethral mucosa, vasculature, connective tissue, pelvic floor
-
What types of receptors play a role in the filling/storage phase? (3)
nicotinic cholinergic, beta-adrenergic, alpha-adrenergic
-
What types of receptors play a role in the voiding phase of micturition? (1)
muscarinic cholinergic
-
What nerve and component of the ANS play a role in voiding?
pelvic nerve- parasympathetic NS
-
What nerve and component of the ANS play a role in filling/storage?
hypogastric nerve- sympathetic NS
-
What nerve plays a role in "guarding reflex"?
pudendal n.
-
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
-
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
-
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
-
The pelvic floor is required for the __________.
guarding reflex
-
How does a pelvic bladder affect continence?
no/decreased pelvic urethra--> incontinence; abdominal pressure on the pelvic urethra prevents urine from entering the urethra
-
What is an important aspect of the PE of an animal suspected of a micturition disorder?
observing the patient urinating
-
Disorders of urine storage. (4)
urethral sphincter mechanism incompetence (USMI), ectopic ureters, overactive bladder (detrusor hyperreflexia), idiopathic incontinence (FeLV/FIV related)
-
Causes of urinary incontinence. (3)
sphincter mechanism incompetence, ectopic ureters, detrusor hyperreflexia
-
Low ______ leads to decreased urethral muscle tone, urethral vascular atrophy, and glandular atrophy; this contributes to ________.
estrogen; USMI [more complex than just low estrogen]
-
Risk factors for USMI. (6)
breed, body weight (>20kg), age at neuter, tail docking, recessed vulva, bladder position
-
Cystometrogram allows you to evaluate... (2)
detrusor function, filling and emptying phase
-
Urethral pressure profile allows you to evaluate... (2)
resting urethral pressure, stress UPP
-
Describe medical treatment of USMI. (2 classes, 5 drugs)
- Alpha1a agonists- phenylpropanolamine, pseudoephedrine
- Estrogen compounds- DES, Premarin, Estriol
-
What are the side effects of estrogen treatment for USMI? (4)
attract males, mammary neoplasia, vulvar swelling, myelosuppression (?)
-
What are the side effects of alpha agonist Ephedrine treatment for USMI? (4)
hypertension, hyperactivity/aggression, decreased appetite, panting
-
What is the most commonly used therapy for USMI?
alpha-agonist PPA (phenylpropanolamine)
-
What are the side effects of alpha agonist PPA treatment for USMI? (5)
hypertension, hyperactivity, changes in appetite, panting, sleep disturbances
-
What is a downside to use of PPA to treat USMI?
may lose effect in some dogs with time
-
[Developing drug] How do GnRH analogs treat USMI?
replace loss of negative feedback, decrease LH and FSH
-
[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
-
4 surgical treatments for USMI (not usually used)?
colposuspension, injectable bulking agents, sling procedures, artificial urethral sphincter
-
Often, male dogs that are diagnosed with USMI actually have ________.
DUD
-
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]
-
How do you definitively diagnose ectopic ureters?
cystoscopy
-
Low compliance of the detrusor and contraction of the detrusor muscle during the filling phase.
detrusor hyperreflexia (instability)
-
What is the therapy for detrusor hyperreflexia? (1 class, 3 drugs)
anticholinergic drugs- oxybutynin, imipramine, dicyclomine
-
FeLV/FIV associated incontinence is __________ in nature, and is thought to be associated with the _________ that can accompany these diseases.
idiopathic; myelopathy
-
4 disorders of voiding.
reflex dyssnergia (DUD), bladder/detrusor atony, automatic (UMN) bladder, autonomous (LMN) bladder
-
Causes of disorders of voiding. (5)
uroliths, neoplasia, functional, anatomic deformity/ stricture, extraurinary (masses outside the urinary system)
-
Clinical signs of disorders of voiding. (4)
straining to urinate, pain on urination, poor urine stream, inability to empty the bladder
-
Incontinence in the male dog associated with a weak urethra. (3)
USMI, pollakiuria, LMN bladder
-
Incontinence in the male dog associated with overflow. (4)
DUD***, bladder/detrusor atony, UMN bladder, other obstruction
-
USMI is less common on male dogs because of the __________.
prostatic plateau
-
In a male dog, you must rule out ________ before you diagnose USMI.
DUD
-
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
-
A local __________ must be intact to tell the urethra to relax as the bladder contracts.
reflex arc
-
To urinate, the _________ must be able to relax.
urethra
-
Poor relaxation of the urethral sphincter during bladder contraction.
DUD- detrusor-urethral dyssynergia
-
Lesions in __(2)__ are associated with DUD.
reticulospinal tract or caudal mesenteric ganglion
-
Describe urine flow of a dog with DUD.
stream starts normal then it slows to a drip or becomes very narrow
-
How do you diagnose DUD?
>0.5mL/kg residual urine in the bladder after voiding
-
What dogs usually present with DUD?
young to middle-aged large breed male dogs
-
What will you find on PE of a DUD patient? (2)
large bladder, normal/enlarged prostate
-
[Differentials] straining to urinate, large bladder after urination. (4)
mechanical obstruction- calculi, stricture, neoplasia; functional obstruction- DUD
-
[Differentials] straining to urinate, small bladder after urination. (5)
inflammation- UTI, calculi, polyploid cystitis, urethritis, neoplasia
-
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
-
Surgical neuter of intact male dogs may resolve signs associated with ______.
DUD
-
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
-
How is acepromazine used as part of the treatment plan for DUD? (2)
smooth muscle relaxant, anti-anxiety
-
Anti-anxiety medications used as adjunct treatment for DUD. (3)
acepromazine, trazadone, fluoxitine
-
If medical treatment fails for DUD, what surgical methods have been used? (3)
urethral stenting, cystostomy tube, botulinum toxin A (controversial)
-
Prognosis for DUD patients is dependent upon... (4)
degree of bladder distention, degree of response to therapy, risks of hypotension, owner willingness to catheterize
-
Functional obstruction dysautonomia has a(n) ________ onset; may present with __(3)__.
acute; constipation, dysuria, and urine dribbling
-
Detrusor atony is secondary to ___________ and separation of ________ in the _________.
over-distension; tight junctions; detrusor muscle
-
Improve bladder emptying associated with dysautonomia with __________ [drug].
Bethanechol (parasympathomimmetic)
-
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)
-
Automatic UMN bladder is caused by CNS lesions cranial to _______.
S1-S2
-
Describe the pathophys of UMN bladder.
loss of UMN inhibition of sphincter--> cannot void on own--> spontaneous voiding when high bladder pressures reached
-
Autonomous LMN bladder is caused by a spinal cord lesion at ________ and a disruption of _________.
S1-S2; local reflex arc
-
Animals with UMN bladder, it is ________ to express the bladder; animals with LMN bladder, it is ________ to express the bladder.
difficult; easy
-
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
-
Detrusor hyperreflexia is treated with _________ to __________.
anti-muscarinics; reduce bladder contraction
-
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.
|
|