The document discusses the micturition reflex, which is the reflex by which the urinary bladder empties when full. It describes the physiological anatomy of the bladder, its innervation by sympathetic and parasympathetic nerves, and the normal pathway of the reflex from bladder filling to emptying. It also discusses some abnormalities in micturition that can occur due to deafferentation, denervation, or lesions disrupting control by higher brain centers.
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Describe the clinical relevance of the nervous control of respiration
The basics of autoregulation of Gloemrular filtration rate. This ppt deals with basic renal physiology, tubuloglomerular feedback, myogenic reflex, juxtaglomerular apparatus and renin angiotensin aldosterone system in brief. P.S.- The ppt has animations so kindly view in slide/presentation mode
Neural regulation of resp by Dr. Mrs Sunita M. Tiwale Professor Dept of Phys...Physiology Dept
Describe Nervous mechanism of regulation of respiration & significance of dual control.
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Micturition (The Guyton and Hall physiology)Maryam Fida
The process by which the urinary bladder empties when it becomes filled.
It is a reflex process
ANATOMY OF URINARY BLADDER BODY = in which urine is collected
NECK = funnel shaped extension and connecting with the urethra.
URETHRAL SPHINCTER.
1. INTERNAL URETHRAL SPHINCTER.
made up of detrusor muscle
2. EXTERNAL URETHRAL SPHINCTER.
made up of skeletal muscle fiber.
EXTERNAL URETHRAL SPHINCTER is responsible for voluntary control of micturition
The walls of the ureter contain smooth musle and are innervated by both sympathetic and parasympathetic nerves.
Parasympathetic stimulation increases peristaltic contraction .
Sympathetic stimulation inhibited MICTURITION REFLEX Filling of urinary bladder 300 – 400 ml
|
stimulation of sensory stretch receptors
present on the wall of bladder
|
Afferent impulses pass via pelvic nerve
|
reaches the sacral segments of spinal cord
|
synapses with postganglionic neuron
|
Efferent impulses via pelvic nerve
causes contraction of detrusor muscle
and relaxation of internal sphincter
|
flow of urine in to urethra and
stimulation of stretch receptors present
in urethra
|
it send afferent impulses via pelvic nerve
|
Inhibition of pudendal nerve
|
Relaxation of external sphincter
|
voiding of urine
Once a micturition begins ,, it is a “self regenerative “.
THAT IS,
the initial contraction of bladder
further activates the receptors to
causes still further increase in sensory
impulses from the bladder and urethra.
These impulses in turn further increases in reflex contraction of bladder.
Reflexes are important to understand for all medical professional it is an assessment tool for patients with neurological conditions.
a god knowledge of primitive reflexes can be effective for pediatric health care as well. it helps us in identifying any developmental delay in children.
Similar to Micturition reflex / Neural control of Urination (20)
Parkinson Plus Syndrome - Multiple System Atrophy: Case Report.
Poster used in CMC MAC 2021.
ABSTRACT
A 61yr/Male, K/C/O T2DM & Parkinson’s disease(PD) on T.Metformin and T.Syndopa for 3 years, presented to us with complaints of unsteadiness of gait, dysarthria, bilateral upper limb tremor. These symptoms started gradually and has been there for last 3 years and it is progressive. Initially, it started as inability to write and difficulty in mixing food due to tremulousness of both hands which worsens with activity. Then it progressed to slurred speech and then to gait unsteadiness. Patient also has urinary incontinence for last 2 years. Patient’s symptoms are more in severity for last 6 months. On examination, patient was having orthostatic hypotension, cogwheel rigidity on bilateral wrist movement and pendular knee jerks. All cerebellar signs were present bilaterally including finger nose test abnormality, past pointing, dysdiadochokinesia, heel shin test abnormality, gross truncal ataxia, wide based gait, impaired tandem walking, gaze evoked nystagmus, scanning speech.
Presence of cerebellar signs, autonomic disturbances, poor response to syndopa, rapid progression, lack of resting tremor at presentation, symmetrical involvement, early speech and gait involvement - are usually NOT seen in PD. So, evaluated further. MRI Brain T2 showed classical cruciform hyperintensity in pons (Hot cross bun sign) & diffuse cerebellar atrophy. Hence the diagnosis MULTIPLE SYSTEM ATROPHY (MSA-C) - Shy Drager Syndrome. This shows the importance of identifying atypical features in PD.
Allergy Induced Acute Coronary Syndrome - Kounis Syndrome: Case Report.
Poster used in CMC MAC 2021.
OBJECTIVE: To discuss a rare occurrence of allergic reaction to NSAID causing Myocardial Infarction.
BACKGROUND: A 21-year-old obese female with no other comorbidities was referred to us with history of chest pain, generalized urticarial rashes and itch suddenly following Inj.IM Diclofenac, which was given for heel pain relief. She was hemodynamically stable, but tachypneic, orthopneic and was having bilateral basal crepitations. ECG revealed significant ST depression & T inversion in II,III,aVF and V2-V6 and ST elevation in aVR. CXR showed pulmonary edema. Diagnosed as ACS following anaphylaxis and loading dose was given along with IM adrenaline, antihistamines, and steroids. Echo revealed global hypokinesia of LV. Cardiac enzymes were elevated. Meanwhile, she had a prompt relief of chestpain, but dyspnea worsened and warranted NIV support. Repeat ECG revealed regression of ST changes correlating with chest pain relief. After 2 days of NIV, patient’s dyspnea improved and weaned from NIV. CAG revealed normal epicardial coronaries. Serial cardiac enzyme levels showed falling trend and ECG was completely normal with no significant ST-T changes. Pre-discharge, repeat echo showed persistence of global hypokinesia. 2weeks later, repeat echo showed dramatic improvement with normal LV systolic function suggesting recovery from myocardial stunning.
RESULTS: This qualifies for the diagnosis of MINOCA (Myocardial Infarction with No Obstructive Coronary Arteries). In the setting of allergic trigger, vasospasm or coronary hypersensitivity is the underlying mechanism- described as KOUNIS SYNDROME.
CONCLUSION: ECG changes and chest discomforts that occur in allergic reactions are not always secondary to distributive/anaphylactic shock. Sometimes heart could be the primarily affected organ by the allergic reaction as in this case. Although <200cases reported globally until 2017, it’s suspected to be frequently overlooked, hence likely to be more prevalent.
Case Report: Brugada Syndrome - A Cardiac Channelopathy.
Poster used for presentation in CMC MAC 2021.
OBJECTIVE: To discuss an interesting case of Brugada syndrome presenting as seizures.
BACKGROUND: A 25-year-old well-informed male presented to us with complaints of seizure on day 3 of an acute febrile illness. He was conscious, oriented, GCS15/15 and system examinations were unremarkable. He had a similar history of seizure during fever 1 year back and was started on anti-epileptics since then and was treated with empirical antibiotics and CSF analysis, MRI brain with seizure protocol and EEG were completely normal during that episode. As described by patient, both episodes were very similar and was like darkening of visual field followed by LOC and bystanders witnessed few jerks involving both sides of body followed by regaining consciousness. This raised suspicion for syncope and ECG revealed RBBB-rSR’ pattern and saddleback STE in V1-V3(type2-brugada pattern-not diagnostic on its own). But on probing, patient revealed SCD in his father at age 42.
RESULTS: Echo revealed structurally normal heart. Expert opinion sought and flecainide challenge test revealed the classical type1 brugada pattern (diagnostic) with coved STE and T inversion in V1-V3 clinching the diagnosis of BRUGADA SYNDROME. Genetic testing for channelopathy was unremarkable. Type 1 Brugada pattern (on provocative testing) along with syncopal event and family history strongly warranted AICD insertion and patient opted for subcutaneous ICD. 6 months later, ICD interrogation revealed occurrence of 1 episode of NSVT, which fell below the ICD intervention threshold.
CONCLUSION: Brugada syndrome is a rare cardiac channelopathy with high risk of SCD in the absence of intervention. Events during fever and family history are very classical. It has male preponderance and more seen in Southeast Asia. All cases of suspected syncopal attacks warrant a thorough search for ECG markers of SCD.
Case Presentation PPT - For TAPICON 2021
Case Report: Allergy Induced Myocardial Infarction - Kounis Syndrome / Coronary Hypersensitivity Disorder / Vasospastic Angina.
Abstract
A young female with no coronary risk factors presented to us with history of chest pain, generalized urticarial rashes and itch suddenly following Inj.IM Diclofenac, which was given for heel pain relief. She was hemodynamically stable, but tachypneic, orthopneic with bilateral basal crepitations.
ECG showed significant ST depression & T inversion in II,III,aVF and V2-V6 and ST elevation in aVR. CXR showed pulmonary edema. Echo revealed global hypokinesia of LV. Cardiac enzymes were elevated. Treated for acute coronary syndrome (ACS) and her pain got relieved. CAG showed normal epicardial coronaries. Repeat ECG showed regression of ST changes correlating with chest pain relief and enzymes were also falling.
Pre-discharge, ECG normalised but echo showed persistence of global hypokinesia. Two weeks later, repeat echo showed dramatic improvement with normal LV systolic function suggesting recovery from myocardial stunning.
This qualifies for the diagnosis of MINOCA (Myocardial Infarction with No Obstructive Coronary Arteries). In the setting of allergic trigger, vasospasm or coronary hypersensitivity is the underlying mechanism - described as KOUNIS SYNDROME.
ECG changes and chest discomforts that occur in allergic reactions are NOT ALWAYS SECONDARY to distributive/anaphylactic shock. Sometimes heart could be the primarily affected organ by the allergic reaction. It is frequently overlooked and its timely recognition and appropriate intervention will improve the outcome.
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
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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
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
2. MICTURITION REFLEX
Definition
Physiological anatomy of urinary bladder
Innervation of urinary bladder
Filling of urinary bladder
Pathway of micturition reflex ( in normal
individuals )
Abnormalities in Micturition
Deafferentation
Denervation
3. What is Reflex?
An involuntary and nearly
instantaneous action, in response to a
stimulus.
Mediated via the “REFLEX ARC”,
formed in spinal cord.
4. Definition....
A reflex by which urinary bladder empties
when it is filled.
Though it is a reflex process, in adults, it
can be controlled voluntarily to some
extent.
5. Physiological Anatomy of
Urinary Bladder…
Urinary bladder is a hollow organ, having parts
namely: BODY – formed by detrusor muscle
NECK - has trigone in its posterior
aspect
Emptying of bladder is mainly guarded by
INTERNAL AND EXTERNAL SPHINCTER
MECHANISM.
INTERNAL SPHINCTER – completely
involuntary. ( smooth muscle)
EXTERNAL SPHINCTER- voluntary. ( skeletal
muscle)
6. Physiological Anatomy of
Urinary Bladder…(Contd.)
DETRUSOR MUSCLE present in
body of bladder is capable of
contraction and expansion, in
response to stimulus.
And hence, it is mainly responsible for
emptying of bladder.
8. Innervation of bladder
Urinary bladder and Internal sphincter
are supplied by sympathetic and
parasympathetic nerve fibres.
Sympathetic supply : L1, L2 ( Hypogastric
nerve)
Parasympathetic supply : S2,S3,S4 ( Nervi
erigentes / pelvic nerve)
9. Innervation of bladder(Cont.)
External sphincter is supplied by
somatic nerve fibres. ( Pudendal nerve).
Pelvic nerve ( nervi erigentes) also has
sensory fibres, which carry impulse from the
stretch receptors present on the wall of
urinary bladder and urethra.
10. Innervation of bladder(Cont.)
CHARACTERISTICS OF SYMPATHETIC SUPPLY :
Stimulation of hypogastric nerve causes,
RELAXATION OF DETRUSOR MUSCLE and
CONSTRICTION OF INTERNAL SPHINCTER.
It results in filling of bladder
So, this nerve is called NERVE OF FILLING.
11. Innervation of bladder(Cont.)
CHARACTERISTICS OF PARASYMPATHETIC
SUPPLY :
Stimulation of pelvic nerve causes
CONTRACTION OF DETRUSOR MUSCLE
and RELAXATION OF INTERNAL
SPHINCTER.
It results in emptying of bladder.
So, this nerve is called NERVE OF
MICTURITION.
12. Innervation of bladder(Cont.)
FUNCTION OF PUDENDAL NERVE :
Pudendal nerve always keeps the external
sphincter in CONSTRICTED STATE.
When this nerve is blocked, external
sphincter relaxes.
Since it’s a somatic nerve fibre, it can be
CONTROLLED VOLUNTARILY.
14. Filling of urinary bladder..
Urine fills the urinary bladder drop by drop
through ureters.
When volume of urine reaches nearly 150ml, first
sense of filling occurs.
However, a marked sense of filling occurs only at
about 400ml.
There is a threshold level in urine volume, which
decides whether to form Micturition reflex or
not.
This threshold level is adjusted by HIGHER
CENTERS OF MICTURITION.
15. CENTERS FOR MICTURITION
SPINAL CENTRES :
Located in sacral and lumbar segments.
Controlled by higher centers of brain.
HIGHER CENTERS :
Has facilitatory and inhibitory centers.
Facilitatory center : Pontine region, Posterior
hypothalamus.
Inhibitory center : Mid brain.
16. Pathway of Micturition Reflex
1) When the volume of urine in the bladder reaches
nearly 400ml, intra-vesical pressure increases…
2) Bladder wall stretches…
3) Stretch receptors on the bladder wall are
activated…
4) Sensory signal is given to spinal centers through
sensory fibres of parasympathetic(pelvic) nerve…
5) Reflex arc is produced in spinal cord…
6) Motor signal is given to urinary bladder through
motor fibres of parasympathetic nerve ( pelvic
nerve)…
17. Pathway of Micturition Reflex ( Cont.)
7) As a result of parasympathetic activity,
DETRUSOR muscle contracts and INTERNAL
SPHINCTER relaxes…
8) Urine passes down into proximal urethra..
9) Again afferent impulse is given to spinal cord…
10) Afferent impulse reaches the higher centers in
brain… ( pathway of afferent impulse inside
CNS is through spinothalamic tracts)…
18. Pathway of Micturition Reflex ( Cont.)
11) If the signal from brain stem isTO MICTURATE
, impulse created from spinal center BLOCK
PUDENDAL NERVE…
12) At the same time, sympathetic efferents are
inhibited…
13) So, External sphincter relaxes and micturition
occurs…
19. Pathway of Micturition Reflex ( Cont.)
11) If the signal from brain stem is NOTTO
MICTURATE, sympathetic efferents are
stimulated…
12) As a result, DETRUSOR EXPANDS and
INTERNAL SPHINCTER constricts…
13) External sphincter remain constricted…
14) So, Urine continues to accumulate in bladder…
20. Pathway of Micturition Reflex ( Cont.)
Once a micturition reflex has occurred but has
NOT SUCCEEDED IN EMPTYINGTHE
BLADDER, the reflex remain in inhibited stage
for 1 minute up to an hour before the reflex
occurs again…
As bladder becomes more and more filled,
micturition reflexes occur more and more often
and more and more powerfully…
22. Abnormalities in Micturition
In all bladder dysfunctions, contractions occur
but they are insufficient to empty the bladder
completely.
So, the RESIDUAL URINE is left in the bladder.
Types :
Deafferentation
Denervation
Absence of regulation by higher centers.
23. Abnormalities in Micturition
DEAFFERENTATION : (i.e.) injury to afferent
(sensory) nerve fibers.
Individual is unaware of distension of bladder.
Voluntary micturition is possible.
If such person fails to micturate at regular intervals,
bladder overflows and causes DRIBBLING OF URINE
/ OVERFLOW INCONTINENCE.
Since there is no afferent supply, bladder wall
remains flaccid ( ATONIC BLADDER).
AUTOMATIC BLADDER – bladder empties
automatically and the sphincter relaxes passively by
increased intra-vesical pressure.
This is seen inTabes dorsalis ( syphilis)-
degeneration of dorsal nerve roots. (TABETIC
BLADDER).
24. Abnormalities in Micturition
DENERVATION: (i.e.) injury to both afferent
and efferent nerves.
Voluntary micturition is completely lost.
Nerve supply completely lost, so it’s called ISOLATED
BLADDER /DECENTRALIZED BLADDER.
Bladder wall remains flaccid, so it’s called FLACCID
NEUROGENIC BLADDER/ HYPOACTIVE
NEUROGENIC BLADDER.
25. Abnormalities in Micturition
ABSENCE OF REGULATION BY HIGHER
CENTERS :
Lesion of superior frontal gyrus ( an area in cerebral
cortex) reduces desire to urinate and difficulty in stopping
micturition once it has started..
Paraplegia patients initiate micturition by pinching or
stroking their thighs, provoking a mild MASS REFLEX.
Lesion in midbrain causes continuous excitation of spinal
micturition centers, resulting in frequent and
uncontrollable micturition ( SPASTIC/ HYPERACTIVE
NEUROGENIC BLADDER)