This document discusses the anatomy, physiology, and neurological disorders of the bladder. It begins with the basic anatomy of the bladder and its parts. It then discusses the nerves involved in bladder function, including the parasympathetic, somatic, and sympathetic nerves. Pathologies that can affect the bladder such as lesions of the spinal cord or peripheral nerves are described. These can result in types of dysfunctional bladders like autonomous, atonic, or spastic bladders. The document provides details on the causes, features, and treatments for different neurological disorders that can cause bladder disturbances.
Provides information concerning gravity, rotation and acceleration
Serves as a reference for the somatosensory & visual systems
Contributes to integration of arousal, conscious awareness of the body via connections with vestibular cortex, thalamus and reticular formation
Provides information concerning gravity, rotation and acceleration
Serves as a reference for the somatosensory & visual systems
Contributes to integration of arousal, conscious awareness of the body via connections with vestibular cortex, thalamus and reticular formation
Acute Transverse Myelitis
Blockage of the Spinal Cord’s Blood Supply
Cervical Spondylosis
Compression of the Spinal Cord
Hereditary Spastic Paraparesis
Subacute Combined Degeneration
Syrinx of the Spinal Cord and Brain Stem
Acute Transverse Myelitis
Blockage of the Spinal Cord’s Blood Supply
Cervical Spondylosis
Compression of the Spinal Cord
Hereditary Spastic Paraparesis
Subacute Combined Degeneration
Syrinx of the Spinal Cord and Brain Stem
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Bladder dysfunction in different neurological diseases
1. Dr. Subhasish Deb
Dept. of General Medicine
Burdwan Medical College
Dr Subhasish Deb, BMCH, General Medicine
2. Pyramidal shaped when empty
Ovoid when full
Parts:
1. Superior surface
2. 2 Inferolateral surf
3. Apex
4. Base
5. Neck
Transitional
Epithelium
Dr Subhasish Deb, BMCH, General Medicine
3. TRIGONE :
• Triangular area in post surface immediately above
bladder neck
• Identified by absence of rugae, i.e mucosa is
smooth here
INTERNAL SPHINCTER:
• At bladder neck, made of detrusor muscle and
elastic tissue
• ABSENT IN FEMALES
EXTERNAL SPHINCTER:
• Skeletal muscle, voluntary control
• In urogenital diaphragm
Dr Subhasish Deb, BMCH, General Medicine
5. Superior and Inferior vesical artieries,
branches of ant. trunk of internal iliac
Veins form a plexus in the infero-lat
surface and drain in internal iliac vein
Most of the lymph in external iliac nodes
Dr Subhasish Deb, BMCH, General Medicine
6. 1. Pelvic Nerve: (parasympathetic)
• Motor + sensory
• From sacral plexus S2,3,4 (Detrusor centre
intermediolateral column of grey matter)
• Motor part = parasympathetic fibres
• Expels urine
2. Pudental Nerve: (Somatic)
• Voluntary control
• External urinary sphincter
• S2,3,4 (nucleus of Onuf) – antero lateral horns of S2,3,4
3. Hypogastric nerve: (Sympathetic)
• T11,T12,L1, L2
• Stores urine
Dr Subhasish Deb, BMCH, General Medicine
10. When bladder is empty:
• Little urine in bladder leads to SLOW sensory
impulses in sensory pelvic nerve. (pelvic afferent)
• The pelvic nerve stimulates the hypogastric nerve at
the thoracic level.
Detrusor relax. (B3) + int sphicn contric (a1)
• The pons also stimulates the hypogastic nrv and
inhibits the pudental ner external sphic contraction.
• Thus urine is not expelled.
Dr Subhasish Deb, BMCH, General Medicine
11. When Bladder is Full:
• Streching of bladder pelvic sensory n sends
FAST signals.
• This is directly carried to the PONTINE
MICTURATION CENTRE, bypassing the thoraco
lumbar regions.
• The Pons:
1. Inhibits hypogastric nv (symp)
a) No relaxation of detrusor (B3)
b) Relaxation of internal shpincter (a1)
2. Stimulates Pelvic efferent nv contr of detrusor
(M3)
3. Inhibits Pudental nv relax. of ext. sphincter
(N)
Dr Subhasish Deb, BMCH, General Medicine
14. AUTONOMOUS BLADDER
Etiology:
•Conus lesion:
•Trauma, tumour, myodysplasia, necrotizing myelitis,
venous agiomas
Features:
-Bladder paralyzed for sensory and reflexive activity
-No awareness of state of fullness
-Voluntary initiation of micturation impossible
-Detrusor tone lost bladder distends
Overflow incontinence
-voiding possible by CREDE’s maneuverDr Subhasish Deb, BMCH, General Medicine
15. Other features:
• Anal sphincter and colon are similarly affected
• Saddle anesthesia
• Abolition of bulbocavernosus and anal reflex and
tendon reflexes in leg
Cystometrogram: low pressure and no emptying
contractions
T/T : Catheterization and anticholinergics
Dr Subhasish Deb, BMCH, General Medicine
16. Crede’s manouver : (MASS REFLEX)
technique for manual expression of urine
from the bladder used in BLADDER TRAINING
for paralyzed patients.
The hands are held flat against the abdomen,
just below the umbilicus. A firm downward
stroke toward the bladder is repeated six
or seven times, followed by pressure from
both hands placed directly over the
bladder to manually remove all urine.
Dr Subhasish Deb, BMCH, General Medicine
17. ATONIC bladder (motor)
Structure affected:
• sacral root or
• peripheral nv
Etiology:
• lumbosacral meningomyelocele,
• tetherd cord syndrome
• Cauda equina: compression m/c- epidural tumour, disc,
radiculitis from herpes or CMV
Features:
• LMN paralysis of bladder
• Sacral and bladder sensations are intact
• Voluntary initiation of micturation lost-loss of cortical fibres
• Overflow incontinence
Dr Subhasish Deb, BMCH, General Medicine
18. ATONIC BLADDER (sensory)
DM & tabes dorsalis
Motor fibres intact
Small fibres – DM
Also seen in acute neuropathies like GB
synd
t/t – intermittent self catheterization
Dr Subhasish Deb, BMCH, General Medicine
19. SPASTIC BLADDER
Etiology:
• m/c multiple sclerosis, traumatic myelopathy
• Myelitis
• Spondylosis
• AVM
• Syringomyelia
• Tropical spastic paraperesis
Dr Subhasish Deb, BMCH, General Medicine
20. If cord lesion is sudden onset detrusor
suffers spinal shock distension and
overflow
When spinal shock subsides Detrusor
overactivity (hyperreflexia) +pt cannot
control external sphincter incontinence
Other features:
• Bulbocavernosus and anal reflex present
• Bladder sensation depends on extent of involvement
of sensory tracts
• Bladder capacity reduced and initiation o voluntary
micturation impared.
Cystometrogram: uninhibitted contractions of
detrusor in response to small volmes of fluid
Dr Subhasish Deb, BMCH, General Medicine
21. Dangerous syndrome due to spinal cord
injury at or above T6
Uncontrolled HTN due to reflex
sympathetic discharge
Pathophysiology:
• A noxious stimulus at t6 excessive symp
discharge HTN (by splanchnic and peripheral
vasoconstriction)
• Baroreceptors react by sending strong vagal
response bradycardia
Dr Subhasish Deb, BMCH, General Medicine
22. • lack of spinal cord continuity
• descending inhibitory response only travels as far
as the level of neurologic injury
• does not cause the desired response in the
sympathetic fibers below the injury therefore, the
hypertension remains uncontrolled.
Above level of injury:
• Bradycardia, nasal congestion, pupilary
constriction, sweating.
Below level of injury:
• Pale, cool skin, pilo erection, distended bladder
Dr Subhasish Deb, BMCH, General Medicine
23. In diseases such as MS, SACD, tethered
cord and syphylitic meningomyelitis
Lesions at multiple levels ie spinal roots,
sacral neurons, their fibres and higher
spinal segments.
Resultant picture is a combination of
sensory, motor and spastic type of bladder
Dr Subhasish Deb, BMCH, General Medicine
24. Confused mental state
Ignores desire to void
Subsequent incontinence
No warning signs of fullness- suddenly wet
Supranuclear type of hyperactivity and
precipitant evacuation
Post part of superior frontal gyrus and
cingulate gyrus
Dr Subhasish Deb, BMCH, General Medicine
25. TYPE LESION SITE
1. Uninhibited bladder Cortico regulatory tracts
2. Reflex bladder Spinal cord above T12
3. Autonomous bladder S2 S3 S4
4. Motor Atonic bladder Motor efferents
5. Sensory atonic
bladder
Sensory afferents
Dr Subhasish Deb, BMCH, General Medicine
26. Neurogenic bladder
Flaccid Mixed Spastic
- Vol. large - Small volume
- Pressure low - involuntary cont.
- Contraction absent - Bladder detrusor
- In: peripheral nv damage dyssynergia
or lesion at S2-S4 - in lesions above
T12
Dr Subhasish Deb, BMCH, General Medicine