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Old 05-14-2012
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Question Small Urinary Bladder that Contracts with Minimal Stretching

A 53yr old female complains of urinary frequency. Studies reveal a small bladder that contracts with minimal stretching. Damage to which of the following structures is likely responsible for this patient's symptoms?

A. pelvic splanchnic nerves
B. pudendal nerve
C. roots of sacral spinal nerves
D. sacral spinal cord
E. thoracic spinal cord

please give explanations too! thanks in advance
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its not B, its not E.

i remember reading in kaplan somewhere (a long time ago) that umm the lower level of the spinal cord wants to contract the bladder but the level higher than it keeps it in check and prevents it from doing so.

urination is a parasympathetic function so id say that sacral cord is PSNS and the one above it (lumbar? pelvic?) is SNS.

so in this question im thinking A.
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I am not fully sure aswell, but it seems as this female is having some problem SANS that is coming from the thoracic spinal cord, which is responsible on spinchter control of the bladder. The problem is that they didn't present it as urinary incontinence. My thinking is that if there is no SANS to oppose the PSANS then you will get a small bladder, and PSANS will be also predominate. leading to small bladder (lack of sphincter control to retain urine, and also every stimulation elicits voiding).
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Default Nice question

Guys,
its Thoracic spinal cord,
as it gives the signs of damage to sympathatic system...and here, we r having problem with internal utethral spincters.
you might wanna see these images..:-)

http://www.hwbf.org/ota/bfc/levin/images/blad.gif

http://www.nature.com/nrn/journal/v9...nrn2401-f1.jpg
Attached Thumbnails
Small Urinary Bladder that Contracts with Minimal Stretching-nrn2401-f1.jpg   Small Urinary Bladder that Contracts with Minimal Stretching-blad.gif  
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Old 05-14-2012
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numbndumb is he right ??? i think it is pudendal nerve damage which caused neurogenic blader. Hypertonic blader can cause small blader with minimal stretching
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I think it'd be damage to the thoracolumbar spinal cord region causing defect in SNS mediated relaxation of the bladder. So I'll have to go with thoracic spinal cord too. But I'd been confident if the option was lumbar spinal cord instead of thoracic.
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Quote:
Originally Posted by slowpoke View Post
I think it'd be damage to the thoracolumbar spinal cord region causing defect in SNS mediated relaxation of the bladder. So I'll have to go with thoracic spinal cord too. But I'd been confident if the option was lumbar spinal cord instead of thoracic.
if thpracolumbal spinal cord was damaged she may have defecation problems too
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the answer is A
pelvic N damage which transmits parasympathetic n. causing contraction of bladder without inhibition from cerebral cortex
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Old 05-15-2012
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The answer is E.Thoracic spinal cord
but im still confused!
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Listening

Let's just be different and say the choice is B

Pudendal irritation will cause frequency & contraction.
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I think Its E. Its like an Upper motor neuron lesion- U have a spastic bladder-any little irritation wd cause it to contract. Sacral spinal cord lesion (like a lower motor neuron) wd cause atonic bladder,which wd jus be overflowing.
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Quote:
Originally Posted by vna.rao22 View Post
I think Its E. Its like an Upper motor neuron lesion- U have a spastic bladder-any little irritation wd cause it to contract. Sacral spinal cord lesion (like a lower motor neuron) wd cause atonic bladder,which wd jus be overflowing.
Correct. And pudendal nerve damage would cause stress incontinence.
I know that it could seem logical at first glance that there is loss of cortical control of bladder leading to an automatic bladder , but don't forget that pudendal nerve damage would also weaken levator ani and THAT leads to stress incontinence(but probably not an atonic bladder).

Sent from my Desire HD
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Quote:
Originally Posted by numbndumb View Post
The answer is E.Thoracic spinal cord
but im still confused!

where is that question from ??ASKing , just as u say u r still confused
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Quote:
Originally Posted by mycoplasma View Post
where is that question from ??ASKing , just as u say u r still confused
Its from USMLE World. but they have not explained it well there. and their answer is E. thoracic spinal cord
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I would go with thoracic spinal cord...

I had a question about a gal who had a C6 fracture and something went wrong with detrusor muscle so she peed all the time
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Considering you already have the answer i dont understand the confusion.

It's a female who has urinary frequency with small bladder and voiding elicted on every stimulation.

Well why is it a small bladder? because it doesnt have sphincter tone - no tone -> the bladder stays small (urine is not retained)

Why every stimulation elicits voiding? because the only thing that contradicts the voiding is the sphincter tone.

What innervates the sphincter? alpha 1 receptors through the sympathetic nervous system.

how those sympathetic fibers get to the sphincter?
Well the sympathetic center is in the hypothalamus descending fibers from the hypothalamus control specific neurons on the lateral horn of the spinal cord in the thoracic and the upper lumbar region, from the lateral horn fibers leave the spinal cord some go through the (greater and lesser) splachnic nerves which reach their end organs e.g the bladder sphincter.

sacral, and pudendal nerves are responsible for the parasympatetic invervation lesion to those will lead to urinary retention in any case
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so basically the concept tested here is knowing that this would be due to a lesion to sympathetic fibers and then knowing which of the options is sympathetic?
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Quote:
Originally Posted by numbndumb View Post
Its from USMLE World. but they have not explained it well there. and their answer is E. thoracic spinal cord

u sure , I did usmle world and did never see this question before ???????
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Old 05-16-2012
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Quote:
Originally Posted by mycoplasma View Post
u sure , I did usmle world and did never see this question before ???????
yes im sure. its one of the anatomy questions
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