Medicine PG poster presentation

1. INNERVATION OF BLADDER
NERVE SUPPLY :
Sympathetic preganglionic fibres arise from last 2 thoracic and upper 2 lumbar segments of the spinal cord and terminate in inferior
mesenteric ganglion, from which postganglionics pass via pelvic plexus to urinary bladder.
Function : sympathetics cause relaxation of detrusor muscle and contraction of internal sphincter.
Parasympathetic preganglionic fibres arise from S2, 3 & 4 segments of spinal cord, pass via pelvic splanchnic nerves and via pelvic
plexus to bladder, where postganglionic neurons are located. (PARASYMPATHETIC IS TO PEE)
Function : These fibres are motor to detrusor muscle and relaxation of internal sphincter.
The pudendal nerve (arising from S2, 3 & 4 segments) supplies the external sphincter of the bladder, which is under voluntary control.
Afferent fibres : Pain fibres pass along sympathetics to T11, 12, L1, & 2 segments, and via parasympathetics to S2, 3 & 4 segments of
spinal cord.
CENTRAL CONTROL OF BLADDER : Dominant Frontal lobe, Pons.
SPINAL CONTROL OF BLADDER: Onuf nucleus in Anterior horn cell of S2.
LMN BLADDER Vs. UMN BLADDER
LMN (AUTONOMOUS Bladder) UMN (AUTOMATIC Bladder)
Failure to Empty Failure to store
Causes:
• Spinal Shock: when reflex arc is not functioning due to initial
trauma
• Conus Medullaris Syndrome
• Cauda Equina Syndrome
• Tabes Dorsalis, Pernicious Anemia, Syringomyelia
• Multiple Sclerosis
Causes:
• SCI: when reflex arc returns after initial trauma to cord passes
• CVA
• Multiple Sclerosis
LESION: LESION:
Complete destruction of Sacral Micturition Above Sacral Micturition Center (above S2)
Center (S2–S4) at S2 or below
Lesion involving exclusively the peripheral innervation of the bladder
Big Hypotonic Bladder (flaccid, areflexic bladder),Tight
Competent Sphincter ,frequent infections.
Results in: Failure to Empty
Rx:
• Intermittent Catheter
• Crede maneuver (suprapubic pressure)
• Valsalva maneuver
• Drugs to induce urination
Small Hyperreflexic, Overactive, Little Bladder
Results in: Failure to Store (Incontinence)
Rx:
Ditropan: direct smooth muscle relaxer
Detrol: anticholinergic
ephedrine: stimulates alpha, beta receptors to allow storage
Reference : ADAMS textbook of neurology Dr.KARTHIK TUMMALA III YR PG 2010