The female bladder lies immediately anterior to which of the following structures:
The bladder is the most anterior viscera in the pelvic cavity. When empty it is entirely situated in the pelvic cavity, but when full expands superiorly into the abdominal cavity. The bladder is a retroperitoneal structure and when full lies adjacent to the anterior abdominal wall.
The empty bladder is shaped like a three-sided pyramid that has tipped over to lie on its side and has an apex, a base, a superior surface and two inferolateral surfaces.
Structure of the Urinary Bladder. (Image by OpenStax College [CC BY 3.0 , via Wikimedia Commons)
In the male the bladder is related:
In the female the bladder is related:
Relations of the Urinary Bladder. (Image by OpenStax College [CC BY 3.0 , via Wikimedia Commons)
The bladder receives efferent sympathetic fibres from the hypogastric plexuses and nerves (T12 - L2).
The bladder receives efferent parasympathetic fibres from the pelvic splanchnic nerves (S2 to S4).
The voluntary external urethral sphincter is innervated by the pudendal nerve (S2 - S4).
General visceral afferent fibres from the bladder, which are stimulated by distension (approximately 300 mL for adults), are conveyed in both the sympathetic and parasympathetic nervous system (the latter being the most important in micturition).
Storage Phase:
At low bladder volumes, afferent firing is low. Sympathetic stimulation keeps the detrusor muscle relaxed and keeps the involuntary internal sphincter closed, inhibiting bladder emptying.
Voiding Phase:
At high bladder volumes, afferent firing increases, causing a conscious sensation of urinary urge. During micturition, parasympathetic stimulation causes the detrusor muscle to contract and the involuntary internal sphincter muscle to relax, facilitating emptying of the bladder. The somatic external urethral sphincter is consciously relaxed during micturition.
The bladder stretch reflex is a primitive spinal reflex where a full bladder, detected by stretch receptors in the bladder wall, activates visceral afferents resulting in activation of parasympathetic efferents and contraction of the detrusor muscle with resultant micturition. Normally this spinal reflex is overridden by the higher centres of the brain to give voluntary control over micturition via the external urethral sphincter.
In spinal cord injury, two types of clinical syndromes are seen:
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Biochemistry | Normal Value |
---|---|
Sodium | 135 – 145 mmol/l |
Potassium | 3.0 – 4.5 mmol/l |
Urea | 2.5 – 7.5 mmol/l |
Glucose | 3.5 – 5.0 mmol/l |
Creatinine | 35 – 135 μmol/l |
Alanine Aminotransferase (ALT) | 5 – 35 U/l |
Gamma-glutamyl Transferase (GGT) | < 65 U/l |
Alkaline Phosphatase (ALP) | 30 – 135 U/l |
Aspartate Aminotransferase (AST) | < 40 U/l |
Total Protein | 60 – 80 g/l |
Albumin | 35 – 50 g/l |
Globulin | 2.4 – 3.5 g/dl |
Amylase | < 70 U/l |
Total Bilirubin | 3 – 17 μmol/l |
Calcium | 2.1 – 2.5 mmol/l |
Chloride | 95 – 105 mmol/l |
Phosphate | 0.8 – 1.4 mmol/l |
Haematology | Normal Value |
---|---|
Haemoglobin | 11.5 – 16.6 g/dl |
White Blood Cells | 4.0 – 11.0 x 109/l |
Platelets | 150 – 450 x 109/l |
MCV | 80 – 96 fl |
MCHC | 32 – 36 g/dl |
Neutrophils | 2.0 – 7.5 x 109/l |
Lymphocytes | 1.5 – 4.0 x 109/l |
Monocytes | 0.3 – 1.0 x 109/l |
Eosinophils | 0.1 – 0.5 x 109/l |
Basophils | < 0.2 x 109/l |
Reticulocytes | < 2% |
Haematocrit | 0.35 – 0.49 |
Red Cell Distribution Width | 11 – 15% |
Blood Gases | Normal Value |
---|---|
pH | 7.35 – 7.45 |
pO2 | 11 – 14 kPa |
pCO2 | 4.5 – 6.0 kPa |
Base Excess | -2 – +2 mmol/l |
Bicarbonate | 24 – 30 mmol/l |
Lactate | < 2 mmol/l |