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Micturition and pain

Terms in this set (68)

Anatomy: urine is produced in the kidneys and travels through the ureters where it collects in the ____________.
bladder
Control of the bladder relies on the ______________ muscle and the ____________ and _______________ sphincters.
detrusor muscle
internal sphincter
external sphincter
There are several receptors: 2 on the bladder, and 1 on each sphincter
muscarinic, beta-adrenergic
alpha1 receptor- internal sphincter
nicotinic- external sphincter
What part of the brainstem contains the micturition center?
Pons
There are 3 important efferent nerve fibers:
what are they?
pelvic, pudendal, hypogastric
what does the pelvic nerve do?
pelvic s1-3- parasympathetic (peeing phase), releases ACH binds M3, contraction of the detrusor
not under our control
voiding
what does the pudendal nerve do?
pudendal s1-3-somatic (our control), ACH binds nicotinic receptor external sphincter, contracts sphincter- holds the urine in
What does the hypogastric nerve do?
hypogastric L1-4- sympathetic (storage phase), releases NE -binds Beta3=relaxation detrusor,
binds Alpha1=contraction of internal sphincter
urine retention
there is one afferent (sensory) nerve involved. What is it?
also the pelvic nerve (parasympathetic)
it is activated when the detrusor is stretched
sending info to spinal cord and pontine reticular formation
UMN incontinence is caused by a lesion between the brainstem and L7. What are the neurologic messages sent?
Afferent information of bladder distention does not register
pelvic n is intact=detrusor tone present
pudendal n intact=external sphincter tone present
hypogastric n= intact but does not receive info to relax detrusor
What is the clinical presentation of UMN bladder?
large turgid bladder, difficult to express, overflow voiding without conscious perception, complete emptying does not occur

Neurogenic functional urethral obstruction (UMN bladder) is generally caused by spinal cord lesions cranial to the sacral segment, which leads to loss of inhibitory signals to the hypogastric and pudendal nerves, which prevents sphincter relaxation on voiding.
How is voluntary control of urination regulated?
controlled by the external urethral sphincter through pathways connecting the cerebral cortex with the pudendal n.
LMN incontinence is caused by an S1-3 lesion. What effect is there on local nerves?
loss of pelvic n results in atonic detrusor muscle
loss of pudendal n results in decreased tone to external sphincter
What is the clinical presentation of the LMN bladder?
volume is variable, flaccid bladder, easy to express, may dribble urine, decrease anal tone (pudendal n.)
What pharmacotherpay can be helpful for UMN bladder?
skeletal muscle relaxant (diazepam)= relaxes external sphincter
alpha adrenergic blocker (phenoxybenzamine)= blocks sympathetic stim
parasympathetic agonist (bethanechol)= stimulates detrusor contraction
What pharmacotherapy can be helpful for a LMN bladder?
none
maybe: parasympathetic agonist (bethanechol)= stimulates detrusor contraction
According to the International Association for the Study of Pain, pain is defined as:
An unpleasant emotional and sensory experience associated with actual or potential tissue damage
The Animal Welfare Act defines a painful procedure as one that:
Would be expected to cause more than slight or momentary pain or distress to a human subjected to the same thing
In the pain pathway, match the part of the brain with the action.

Transduction, transmission, modulation, projection, perception

- Dorsal horn of spinal cord
- Peripheral nerves
- Cortex/thalamus
- Tracts, postsynaptic dorsal column
- Skin, muscle, bone, joint viscera
Transduction: Skin, muscle, bone, joint viscera
Transmission: Peripheral nerves
Modulation: Dorsal horn of spinal cord
Projection: Tracts, postsynaptic dorsal column
Perception: Cortex/thalamus
Transduction involves changing the stimulus into an action potential. It begins at the nociceptive receptors in the sensory nerve endings. Receptors respond to chemical, thermal, mechanical, and electrical stimuli. Some are polymodal (respond to more than 1 stimulus) vs. some are unimodal. Where are the cell bodies located (body vs head)?
Dorsal root ganglia if sensory nerves originate in the body.
Trigeminal ganglia if sensory nerves originate in the head (trigeminal, facial, glossopharyngeal, vagus nerves)
Transmission involves sensory and motor nerve impulses (APs) transmitted through a peripheral nerve to the spinal cord. Peripheral nerve contains afferent (sensory) and efferent (motor) nerve fibers. Near the spinal cord the afferent fibers separate to form the _________ _________, the efferent form the __________ ___________.
dorsal root; ventral root
Modulation (amplification or suppression) of AP in the spinal cord. Afferent sensory nerve fibers enter the SC via the dorsal roots of spinal nerves. Efferent motor nerves are located in the ventral horn. Nerves separate and innervate second order neurons in the ______________________________________ (13 words). It contains interneurons and ascending neurons with sensory info. Interneurons send output to brain and ventral horn.
Lamina of the gray matter of the dorsal horn of the spinal cord
Projection includes the relay of the AP to the brain, which culminates in perception. Sensory info is projected to ___________ ____________ of the brain stem and surrounding nuclei by multiple parallel circuits before converging in the ____________.
reticular formation; thalamus
The thalamus integrates and relays info to the somatosensory cortex, which projects info to cortical areas including the limbic system. The limbic system includes SIX parts of the brain according to this document. What are they?
- Cingulate gyrus (involved in behav and emotion)
- Amygdala (fear & anxiety)
- Hippocampus (memory)
- Hypothalamus (symp autonomic activity)
- LC (arousal, vigilance, behav)
- Portions of PAG (fight-or-flight, stress-induced analgesia)
________________ involves the integration, processing, and recognition of sensory info in the brain.
Perception
Pain can induce catabolism, impair respiration, delay wound healing, prolong hospital stays, increase morbidity and mortality. Which vet group has a position statement about managing pain?
AVMA position statement: "The AVMA believes that animal pain and suffering are clinically important conditions that adversely affect an animal's quality of life. Drugs, techniques or husbandry methods used to prevent and control pain must be tailored to the individual animals and should be based in
part on the species, breed, age, procedure performed, degree of tissue trauma, individual behavior characteristics, degree of pain and health status."

AAHA is considering the topic of pain management by its member practices, and setting standards
Rats given morphine post-op for mammary adenocarcinoma had rates of mets ____% less vs. rats not given morphine.
70%!
What are some reasons vets don't treat pain?
-lack of knowledge, more recent graduates are more likely to treat
-failure to recognize pain
-fear of adverse reaction to medications
-aggravation of logging controlled drugs
-belief that some pain is helpful in keeping animal from being overactive postop
-sex! Female vets are more likely than men to give higher pain scores to patients and to treat pain
-cost
An accurate estimate of animals receiving needed analgesia is lacking. In one study in the late 1980's, <40% of dogs undergoing major surgery were given pain meds. Usage has increased, but by how much? Canadian vet survey in mid 1990's indicated <_____% of animals were given pain meds post-op.
<25% :(
There are 3 ways to categorize pain: embryologic origin, mechanism, and duration.

What are the 3 types based off embryologic origin?
- superficial: caused by stim of pain receptors in skin, fast pain = stim of nociceptor with myelinated fibers vs. slow pain = stim of nociceptor with nonmyelinated fibers
- deep: arises from underlying structures like muscles, ligaments, tendons, periosteum, joints
- visceral: stretch receptors in visceral walls sensitive to stretch and tension
There are 3 ways to categorize pain: embryologic origin, mechanism, and duration.

What are the 2 types based off mechanism?
- inflammatory pain: initiated by chemical mediators secondary to tissue damage
- neuropathic pain: caused or initiated by primary lesion or dysfxn of central or peripheral NS
What defines chronic pain vs. acute pain?
- Acute: lasts for duration of healing process, accompanied by autonomic changes, responds to analgesic tx
- Chronic: may have no obvious cause or temporal onset, lasts >6 mos, persist beyond expected healing time, maybe alteration in NS that allows painful state to continue without continuous cause, often doesn't respond to tx
List signs of acute pain vs. chronic pain.
- Acute: anxiety, tearing, changes in eye expression, fixed and dilated pupils, restlessness, increase or decrease in physical activity, lameness, change in appetite and personality, self-mutilation, vocalization, salivation, tachypnea/tachycardia, elevated; glucose, cortisol, ACTH, catecholamines
- Chronic: guarding behavior in movement and posture, avoidance of pain aggravating influences, seeking of pain-relieving factors and environments, self-care of painful region, stress, weight loss, inappetence, hirsutism
List some physiologic and biochemical indicators of pain (see chart at end of doc).
- HPA system: adrenal corticosteroids can be measured in plasma, saliva, feces, good for acute pain but not chronic, less sensitive to low grade pain
- Endogenous opiate systems: monitor endorphin and enkephalin levels
- Neurologic: EEG or brain mapping
-Metabolic changes: electrolyte imbalance, acidosis, glucose and lactate imbalance
-Cardiovascular: heart rate, blood pressure
- Respiratory: changes in rate, pattern, blood gases, tidal volume
There are 4 pain scoring systems:
- Numerical rating system (NRS)
- Simple descriptive system (SDS)
- Visual analogue scale (VAS)
- Glasgow scoring system (JAVMA 2004)

What species was the Glasgow scoring system developed for?
Dogs.

Development of a questionnaire for owners of
dogs with chronic pain, 109 different descriptors of behavior to choose from that are indicative of the quality of life.
13 categories looked at: activity, comfort, appetite, aggression, anxiety, alertness, dependence, consistency, contentment, agitation, compulsion, posture-mobility, extroversion, and introversion.
Researchers hope to develop a similar questionnaire for cats and horses.
Neuters can be performed open or closed depending on if WHAT is incised or not?
A. ductus deferens
B. parietal vaginal tunic
C. fascia
D. visceral vaginal tunic
B. parietal vaginal tunic
According to The Perfect Puppy Book by the Harts, which 3 of these behaviors will not be helped by neuter?
A. marking
B. interactions with children
C. calmness
D. aggression to UFP
E. destruction
B. interactions with children
C. calmness
E. destruction
According to Houpt, what percent of spraying will be cured with kitty neuter?
A. 5-15%
B. 65-70%
C. 85-90%
D. 95-100%
C. 85-90%
Match the procedure with the description:
1. open cat neuter
2. closed cat neuter

A. ligation, overhand knot or square knot of ductus deferens to testicular vessels
B. overhand knot with incisions left open
1/A. Open: ligation, overhand knot or square knot of ductus deferens to testicular vessels
2/B. Closed: overhand knot with incisions left open
What tendon do you cut with a tendonectomy of a kitty cat?
A. deep digital flexor
B. superficial digital flexor
C. long plantar tendon
D. medial collateral tendon of the hock joint
A. deep digital flexor
Why is tooth removal used in dogs? Cats?
uncontrollable aggression (probably still an unethical thing) and stomatitis in cats
T or F) AAHA does not official oppose cosmetic tail docking

T or F) the Kennel Club of the UK doesn't allow docked dogs to show.
AAHA does not official oppose cosmetic tail docking False- they do oppose it for cosmetic reasons. Way to go AAHA.

The Kennel Club of the UK doesn't allow docked dogs to show. True. Way to go UK
- Tail docking in dogs: surgical removal should occur before ____ day(s) old.
- Banding of the tail until it falls off should occur within the first ____ day(s)
-After banding, the tail detaches after ____ days.
- Tail docking: surgical removal should occur before 3 day(s) old.
- Banding of the tail until it falls off should occur within the first 1 day(s)
-After banding, the tail detaches after 3 days.
What's the fancy pants word for ear cropping?
cosmetic otoplasty
T or F: AAHA does not official oppose cosmetic cropped dogs.

T or F: the Kennel Club of the UK doesn't allow cropped dogs to show.

T or F: AVMA has recommended to the AKC and breed association to not list cropped ears as a breed standard.
AAHA does not official oppose cosmetic cropped ear dogs. false- they DO oppose

the Kennel Club of the UK doesn't allow cropped ear dogs to show. true

AVMA has recommended to the AKC and breed association to not list cropped ears as a breed standard. true
T or F: Slatter 2nd addn. 1993 (fancy sx book) says that cropping ears can be helpful to prevent damage to the pinna and ear infection.
False- this book said there is no medical reason to crop ears
Olfactory tractotomy is used to transect the olfactory tract and you approach through the frontal sinus.

According to Houpt is _____% successful to reduce cat urine spraying.

According to Slatter sx book, it is ____% successful in males and ______% successful in females.
According to Houpt is 50% successful to reduce cat urine spraying.

According to Slatter sx book, it is 50% successful in males and 90% successful in females.
In one old age procedure (called ischiocavernosus myectomy) talked about by Houpt successfully treated 7/10 refractory spraying male cats. What does this procedure do?
cuts muscle at pelvis and penis so the cat can't erect/extend penis to direct urine at a specific area :(
What is a perineal urethrostomy actually do? (apparently this used to be used for spraying cats)
excision of ischiocavernous and amputates penis
What is the procedure that removes a portion of the edge of the vocal cord (some cases will start barking after healing 6-8 weeks later) or in some cases, you just remove the vocal cord? aka debarking surgery

A. Epiglottisectomy
B. Ventriculocordectomy
C. Arytenoidectomy
D. Posterior cordectomy
B. Ventriculocordectomy
Debarking is supposed to result in permanent loss of normal voice but dogs can usually still make a SOFT OR HARSH noise?
harsh
According to Line, Hart (1985, JAVMA), the following behaviors decrease by what percentage in post-pubertal horses after castration:
1. aggression to people
2. aggression to horses
3. sexual behavior
1. aggression to people- 60-70%
2. aggression to horses- 40%
3. sexual behavior- 60-70%
What are three surgical procedures that are used to "treat" cribbing?
1. buccostomy (not explicitly listed as unethical)
2. cut CN 11 (unethical)
3. myectomy of the ventral neck muscle (unethical)
Buccostomies create bilateral buccal fistulae over the 1st OR 2nd cheek tooth to prevent development of an oral vacuum.
1st cheek tooth
Cutting the ventral branches of CN 11 (remember the name?) is used to prevent motor activity of which muscle?
A. sternocephalicus
B. brachiocephalicus
C. trapezius cervicis
D. splenius
A. sternocephalicus

accessory nerve
Neurectomy of the accessory nerve [is/ is not] effective long term and in the short term is considered 0-80% effective (whatever that means).
IS NOT effective long term.
Bilateral myectomy or myotomy of three possible muscles is 60-90% effective at treating cribbing. Which muscle is NOT listed as one of the ones you may snip?

A. sternohyoideus
B. sternothyroideus
C. omohyoideus
D. sternocephalicus
D. sternocephalicus
What effect does castration have on cattle meat quality?
marbling
Surgical castration of bulls is successful for bull to bull aggression (no citation). There are two methods- one is with the emasculator and leaving the incision open and the other one is the Burdizzo method. How do they work?
Just crush tissue
THIS is caused by the accumulation of two compounds (androstenone and skatole). You prevent this by castrating pigs prior to slaughter.
boar taint (most pigs castrated prior to 3 weeks)
T or F: JAVMA 2002 study found cows with docked tails are cleaner than cows with full tails.
False! no difference in cleanliness
People are dicks- Australia says you can do cattle tail docking < 6 months with local anesthesia. You can also band them at 18 months, where their tail falls off HOW MANY WEEKS LATER? Or you can use an emasculator and a hot docking iron without any anesthesia.
tail falls off 3-7 weeks later
Journal of Dairy Science said that docking tails resulted in improved comfort for all but which of the following:
A. milker
B. handler
C. cow
c. cow
Why do people dock pig tails?
prevent tail biting
Tail docking of pigs should occur within....
A. the first hour of life
B. the first week of life
C. the first month of life
D. whenevs
B. the first week of life
In addition to tail docking, what other thing do people do to baby piggies? (not related to castration)
teeth clipping to try to prevent trauma to littermates' faces and sow's underline
For all horses regardless of age at castration, the occurrence of geldings showing stallion- like sexual behavior and aggression toward horses is WHAT PERCENT and the occurrence of stallion like aggression towards people is WHAT PERCENT?
For all horses regardless of age at castration, the occurrence of geldings showing stallion-like sexual behavior and aggression toward horses is 20-30% and the occurrence of stallion-like aggression towards people is 5%.
Freebee- just stuff people do to young cattle to try to stop sucking (1988 text of LA sx)
1. nose ring with serrated sheet metal attached along 1/3 of circumference, recipient will move away
2. Two hog rings in ventral surface of tongue, anterior to frenulum. Satisfactory results in 60% of cases
3. V-shaped trough surgically formed on ventral tongue between frenulum and tip to prevent tongue from curling
4. Surgical removal of ½ of tongue anterior to frenulum (GOOD LORD. )
Sad ending.
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