Renal | Micturition Reflex

all right engineers in this video we're going to talk about the Nick tuition reflex so first things first we need to understand that what is this little anatomy part here so again these little tubes here you're ureters right you have a left and a right ureter this right here is the bladder and the bladder is a really really muscular layer you see this red coloring right here that is the smooth muscle layer and it's actually called the detrusor muscle so what is this red layer if you're cold this is actually consisting of a muscle called

the detrusor muscle and it's actually this thick muscular layer of the bladder there's another component that we have to talk about you see these little red muscles here surrounding the actual in this point of the bladder getting ready to go into the ureter because this is the urethra these little muscles right here are actually called the internal urethral sphincter and then these ones down here that are closer to the sump let's point down here let's say that I actually have a couple other muscles in this area I'm going to highlight it here like this bluish

color let's say that I do it like this there's other muscles in this area like this this blue muscle we'll call that the deep transverse / aeneas muscle but this red muscle layer right here that's actually internal to this part here this structure right here is called the external urethral sphincter and then again this is a component of the urogenital diaphragm which is made up of the external urethral sphincter and the deep transverse perennials muscle so this is actually a component of the uro genital diaphragm okay now what happens is let's say that our bladder

is empty let's say that there's no urine of the bladder or in this case there's very little urine in the bladder let's say that there's just a tiny bit of urine in the bladder the thing that there's like 10 milliliters of urine in the bladder so there's about 10 to 20 milliliters of urine usually in the bladder after you've evacuated the bladder so after you've gone in urinated you dropped out that load there's only going to be about 10 to 20 milliliters left okay now this is they're going to take into consideration that this is

going to be an empty bladder pretty much an empty bladder well the thing is what actually controls our bladder is these reflexes and our actual central nervous system so let's look at these reflexes and how they're actually controlled so now that is these stretch receptors these stretch receptors are located within the detrusor muscle wall layer and they respond to stretch on the actual bladder now if there's very little urine coming into the bladder there's very little urine in the bladder then the impulses that are going to the actual spinal cord are going to be less

now what part of the spinal cord are we talking about well there's two parts of the spinal cord that we really need to make sure that we understand this is the sacral region to the spinal cord okay so sacral spinal cord but specifically this is around s2 s3 and s4 okay this right here we're going to call this the thoracolumbar part of the spinal cord okay primarily this is going to be around T 11 to l2 these are some important parts of the spinal cord that we need to look at so thoracolumbar regional spinal cord

and sacral region of the spinal cord this is from T 11 to a level 2 and this is s 2 s 3 and s 4 another part which is a part of the brainstem is actually going to be the pons there's two centers in the pons that we're actually going to have to talk about one is the pontine storage center and the other one's gonna be the pontine victor Isham center and the last one is going to be your higher brain centers in this case we're going to say this is your actual cerebral cortex so

this is the cerebral cortex picking up the actual sensations and making you consciously aware of them okay let's say that there's very little urine in the bladder so the stretching is going to be very minimal very minimal stretching and very little activation of these sensory afferent neurons if that's the case then it's only going to send very slow and very few action potentials down the sensory afferent neuron if very few action potentials are coming then when they get to the spinal cord there's two things that can happen one thing that's going to happen is is

you're going to have these fibers here let's do this one here in black you're going to stimulate this fiber here which is going to take this information up into the thoracic and lumbar region the spinal cord so whenever these very very few sensory impulses are coming in it's going to stimulate these neurons that will take these ascending fibers upwards into the thoracolumbar region of the spinal cord when it gets up here it comes out in sign APS's on these actual motor neurons preganglionic motor neurons located within the lateral gray Horn of the spinal cord let's

draw these ones in this brownish color so it's going to sign apps on these guys and a lateral very horn out of the laboratory horn they're going to come out here and they're going to sign apps on the actual cell bodies of the postganglionic motor neurons located within a ganglia this ganglia is generally the inferior mesenteric ganglion and when it's synapse is their sign axis on these neurons these postganglionic motor neurons which come out here into two destinations one is it goes to the defroster muscle the other one it actually comes over here to the

internal urethral sphincter now this nerve these nerves here that are coming out of the inferior mesenteric ganglion is actually a part of the hypo gastric nerve okay so the hypogastric nerves are going to go to two points one is they're going to go to the detrusor muscle wall and they're actually going to release a special chemical that chemical that they're going to release is actually going to be Norrell epinephrine same thing over here at the internal reader shrinker it's going to release a chemical called Noro epinephrine now what's going to happen is they have receptors

that are on the trustor muscle wall and you have receptors on the internal rates of chancre on this the trustor muscle you're going to have these specialized receptors these blue receptors I have here he sees blue receptors this is specifically going to be a beta 3 ad you're nergic receptor beta 3 adrenergic receptor there's very little at beta-2 adrenergic receptors 97% of them are beta 3 when norepinephrine is released it's going to bind on to this receptor and when it binds on to this receptor it's actually going to cause potassium on is to leave the

smooth muscle cells which causes it to relax so in other words what is this actually going to do to this actual muscle layer then it's going to inhibit the beta 3 adrenergic receptor right what's going to kind of act on the beta 3 a generic receptor which is going to produce the smooth muscle to have potassium ions leave the cell which is going to cause relaxation of that muscle so it's not going to contract then it's going to release norepinephrine onto these receptors over here look at these receptors these receptors here are actually present on

the internal urethral sphincter now the job of the internal urethral sphincter as it's designed to be able to constrict the urethra and prevent urine from coming out here into the actual what so for example if it was the female they just would have any arethe ro but if it was the male they have what's called a prostatic urethra amendment or Sarita and a spongy or penile urethra so what the internal urethral sphincter is doing it's constricting there at that point of the bladder and preventing urine from leaking out into the urethra okay it has a

specialized receptor and this receptor is actually called a alpha one adrenergic receptor this alpha one adrenergic receptor when norepinephrine comes over here and acts on to this he's going to activate this receptor and stimulate the contraction of this internal urethral sphincter to keep the actual urethra closed because you don't want your own to come out you just urinated so that's going to do that right there then another thing is going to happen we have other nerves over here and let's do these ones and a nice let's do something purple okay then you have these other

ones over here in the sacral region of the spinal cord you have these parasympathetic nerves okay these pelvic nerves and what happens is the impulses will come up and activate this sympathetic ganglion right activate the sympathetic activity what can happen is some of these impulses can come up words let's say let me keep following these impulses upwards they come up to the pons and they stimulate a specific point in the pons and then also the information can continue to go up to the cerebral cortex all right and let the through the cortex know that the

bladder is pretty much empty what will happen okay the pons actually has two centers let's show one Center here in this actual purple or no students orange color assuming that's one color so one thing that we're going to have right here this Center right here that red that orange center is going to be called the pontine storage center what happens is our pond and our cerebral cortex knows whenever the actual bladder is empty or it's pretty much just evacuated right now because of that because we have these impulses coming up what will happen is the

cerebral cortex will tell the pontine storage center to become activated and it will inhibit another center there's another Center over here let's do this one in this bluish color here this is actually going to be called deep pontine micturition center this that one is called the pontine micturition center what will happen is this actual cerebral cortex the higher brain centers will come over here and it will stimulate the pontine storage center and it will inhibit the pontine vector ition center when the pontine storage center is stimulated due to him knowing that our bladder is pretty

much empty he's going to send down these descending fibers and what's going to happen is let's say that he sends these descending fibers down as these descending fibers come down they're actually going to do come over here look at this they're going to come over here and they're going to sign apps on that inferior mesenteric of the preganglionic nerves that will go to the inferior mesenteric ganglion what is it going to do there it's going to let's do this a nice darker color here it's going to stimulate this actual sympathetic nerves to continue to have

this flow through the hypogastric nerve relaxing the actual smooth muscle of the detrusor wall and actually keeping the internal shrinker directed at the same time these other descending fibers will continue to keep coming down and they'll come over here to this pre ganglionic motor neurons that are actually a part of the parasympathetic nerves right within the saiga reason let spinal cord s 2 2 s 3 and s 4 right these actual nerves are going to come over here and what they do is they come to a specific part of the bladder which is added trust

or muscle and they release a chemical known as acetylcholine so they release a chemical called ACH acetylcholine this acetylcholine acts on specialized receptors present on the detrusor muscle wall layer these receptors are called m3 receptors which is muscarinic type 3 receptors but because the pontine storage center is sending these impulses down it's actually going to not stimulate these parasympathetic neurons so they will be inhibited these neurons if they are inhibited the action potentials that they're sending is very very low or pretty much not happening whatsoever if that's the case they don't release acetylcholine they don't

act on the muscarinic type 3 receptors what does the ctul Coleen's effect on the muscarinic type 3 receptors it actually stimulates these receptors to increase the calcium levels inside of the smooth muscles to cause contraction we don't want the bladder can contract because we just emptied the bladder we don't want it to do it again because we wanted to stay empty right we wanted to keep that actual volume and let it collect until the necessary stretch drives are desired after go to the bathroom okay we'll talk about that in a second okay so again quick

recap here first thing sensory afferent fibers are activated they send these impulses to the sacral region of the spinal cord right once they do that they send these reflexes up to the actual preganglionic motor in neurons and the lateral gray Horn of the spinal cord specifically T 11 to l2 these pre ganglionic motor neurons come out to an inferior mesenteric ganglion synapse in that area the postganglionic motor neurons which are the via the hypogastric nerves will come out and innervate the de Trussell via the beta 3 adrenergic receptors and cause the muscle to relax right

so this will relax it will come to the actual internal urethral sphincter and act on the alpha-1 adrenergic receptors and this will produce contraction to keep the actual urine in the bladder don't let it evacuate yet then the impulses will continue to go upwards to the higher brain centers and let the pons specifically the pontine storage Center know and the cerebral cortex note they will become aware of that and they'll send down these descending fibers to the actual sympathetic preganglionic motor neurons stimulating these neurons and causing more sympathetic outflow to go on top of that

it also have these descending axons that come down here to the parasympathetic division inhibit them and prevent their outflow one more point - there's another point here where it actually comes off to the actual cell bodies of the anterior grey horn let's do these ones and red-top them these ones here are actually going to sign apps on the cell bodies of the anterior grey horn these ones are going to come out through a special nerve and this nerve is actually called the pudendal nerve pudendal nerve but here's the thing we mentioned the parasympathetic and sympathetic

that's a part of the autonomic nervous system the pudendal nerve is a part of your somatic nervous system okay cool and what it does is it comes to the actual external urethral sphincter and actually acts on these specialized receptors in this area and knead this area they have what's called Niko 10 ik type 1 receptors right so they have nicotinic type 1 receptors and basically it releases a chemical called acetylcholine acetylcholine will stimulate these nicotinic receptors and cause the muscle to contract if it contracts it prevents any urine from coming out that's good because this

is controlled by our actual somatic nerves so we have voluntary control over that muscle now we know what happens whenever the bladder is empty let's talk about whenever the actual bladder starts accumulating here and starts stretching and then we have to go all right so now say we come over here to this right diagram in this right diagram we're going to say that Uranus collected for a while all right we're going to say that it went up to a certain stimulus because you know there's a a certain amount of volume that will actually trigger the

actual bladder to have these significant stretch receptor reflexes because generally stretch receptor reflexes aren't really activated until you hit a certain volume really around 200 milliliters when the actual stretch receptors start becoming super activated sending a lot of impulses to the spinal cord because those impulses that we mentioned over there are really really slow impulses these are going to be really fast and pull so we're going to talk about so now let's say that the bladder is accumulated a lot of urine it's got up to a point of about 200 let's actually do this over

here it's got up to a point about 200 milliliters of urine 200 milliliters of urine is usually where we start developing the desire to have to go to the bathroom okay now the same thing happens the same thing happens over here so let's come back over here for just a second let's say that you have two milliliters urine and you actually become consciously aware so let's say that these impulses these actual buzz sensory impulses are coming to the actual steak original spinal cord sending these impulses up and they go up to the cerebral cortex you

become aware of the volume within your bladder like boom gotta go right but let's say that you're doing something else is not appropriate for you to just you know whip your thing out and start peeing all over the driveway you can't do that you have to find the appropriate time to do that so what are you going to do your actual central nervous system will actually send down these impulses and continue to stimulate the pontine storage center if it continues to stimulate the pontine storage center what's going to happen it's going to send these impulses

out to the sympathetic nerves the sympathetic nerves will actually cause the relaxation of the bladder and constrict the internal resource finger you'll also inhibit the parasympathetic neurons so that they don't trigger the contraction of the bladder you'll also activate the somatic nerves to keep that external urethral sphincter tight so that you don't have any urine coming out that's what happened but let's say you're you know you're your Russian here you're not being you're not you don't even know if you're going to be able to make it to the actual bathroom and it starts accumulating even

more let's say gets up to about 400 to 500 milliliters this is usually whenever people usually just start urinating right the bladder is pretty intense it can actually expand up to about maximum of 800 to a thousand milliliters but beyond that it actually starts tearing it actually so generally for most people around 400 to 500 milliliters is usually where the act of voiding is going to begin all right but for some you know freaks out there they might be able to hold that in for a lot longer no no idea how I can't do that

but again let's say it gets to about 400 to 500 milliliters now what's going to happen okay let's look at those stretch receptors we have these stretch receptors over here right and these stretch receptors let's say that they're going to be stimulated very powerfully because there's a lot of stretch here there's a lot of stretch across this actual bladder wall if there's a lot of stretch than what's going to happen it's going to go to the actual and this is going to have your gangland dorsal root ganglion which would take the information into the actual

posterior gray horn then what will happen in the posterior gray horn you'll actually send these impulses where upwards right so it's going to go upwards into the thoracolumbar region of the spinal cord and what's going to happen is it's going to be really interesting it doesn't sign apps at this part of the spinal cord it actually passes through the thoracolumbar region of the spinal cord it doesn't give off any axons so it's thin as these impulses upwards and it goes straight up to the pons and lets off some impulses to the pond and since this

impulse is up to the actual cerebral cortex now there was two centers if you remember one was actually called the pontine mikta raishin center and the other one we said was the pontine storage center in this situation the urine is accumulated right you've already held it a couple different times so say that they got to 200 milliliters you decided to hold it got to 300 milliliters you decided to hold it got to 400 500 milliliters can't hold it no more I got to go since these impulses are forcing the cerebral cortex your cerebral cortex becomes

aware of your actual desire to go to the bathroom right and it says all right I got to go anyway so if it's not appropriate for you sorry buddy it's time to go so what does it do it sends down these actual axons let's draw these ones in brown here let's say this is the cerebral cortex neurons here it says these axons down here and sinuses there at the actual pontine make tuition centre and the pontine storage center right so this one is the pea MC which is the pontine declaration Center and this is the

pontine storage center so PS see what it will do is it'll stimulate the pontine declaration Center and inhibit the pontine storage center what does that mean same what's going to happen is those axons are coming down to stimulate the pontine I'm sorry to stimulate the sympathetic motor on neurons that we're in the thoracolumbar regional spinal cord they won't be stimulated anymore so now look what happens coming here from the pontine the curation center it's going to send these axons down and it's going to come to the thoracolumbar region the spinal cord and we had that

colors that do to brown you got to do to brown there it's going to come to this the rack of the lumbar region the spinal cord around T 11 to l2 and if you remember these motor neurons were coming out here to the detrusor muscle right acting on what receptors they were acting on the beta 3 adrenergic receptors and they were inhibiting these ones right they were keeping them relaxed well now you're gone you're not going to actually stimulate these guys these guys are going to be inhibited so their impulse is going to the actual

beta 3 a generic receptors will decrease are completely cease now another thing happens oh and then what was the other fibers that came over here look at this this is the really really important one it's also going to release norepinephrine over here and what was this receptor right here guys this was the alpha one alpha one adrenergic receptor alpha one add your nergic receptor what did we say no we're at the nephron did to this receptor it stimulated this receptor right and caused it to contract well now if the impulse is going to this guy

is decreasing or pretty much absent what's going to happen here it's no longer going to be stimulated and contract you're not going to release a lot of norepinephrine you're not going to activate these alpha one adrenergic receptors and you're going to inhibit them what will happen then this will relax and as this starts relaxing gearing can then be led out of the bladder right well let's see what else helps to facilitate this action then these descending motor nerves that were coming from the actual primary mob I'm sorry not the primary motor this is the pontine

micturition Center it'll send these axons down here and it will come over here the sacral region of the spinal cord and it will act on these neurons over here which we had in purple and these were actually the parasympathetic preganglionic motor neurons when synapse is here these parasympathetic preganglionic motor neurons will actually come over here and do what they'll actually act on me what m3 receptors the muscarinic type 3 receptors now it was inhibited before but now it's going to be stimulated so the action potentials sent down this axons because it's actually going to sign

apps what's called an intramural ganglion which is pretty much on or in the actual target organ and when the impulses increases it's going to release a lot of acetylcholine if you release a lot of acetylcholine it's going to stimulate this m3 receptor if the m3 receptor is going to be stimulated what's going to happen to the action of the trustor muscle it's going to be stimulated and it will contract if the de Trusts or muscle starts contracting what is it going to want to do it's going to want to start squeezing the urine out of

the bladder and not only that but look what else we did not only do we stimulate the actual bladder to contract by stimulating the m3 receptors and by inhibiting the base of three adrenergic receptors but we also relaxed the internal urethral sphincter and now that that relaxed the actual bladder can evacuate some of the urine out here into the urethra because now these are relaxed and now look with the uranus the urine is actually coming out here now but guess what this part right here is still holding on for dear life let's say that you're

running to the bathroom as fast as you possibly can and this this sphincter is just like I can't hold it any longer but you have just enough stimulation from what part here remember the cerebral cortex also has these descending axons that come down here to the ventral gray Horn of the spinal cord and in the venture agree Horn of the spinal cord you have these somatic motor neurons right and these somatic motor neurons were coming over here and stimulating what over these receptors here this was called the nicotinic nicotinic receptors right and they were stimulating

these out receptors and causing muscle to contract well guess what happens here these impulses coming down to the Ponte mech duration centers like sorry buddy I hope you made it because it inhibits this Center only this inhibits these neurons if these neurons are inhibited they will not send very many action potentials are pretty much no action potentials out to the external urethral sphincter if the action potentials are pretty much gone are not occurring then what happens to this nicotinic 1 receptor it's no longer stimulated it's inhibited if it's inhibited what happens to the external urethral

sphincter it relaxes so this muscle relaxes if this muscle relaxes then what can happen the yarn can continue to flow out and then we have other muscles that can actually increase the flow of the yarn right like the certain Kegel muscles and this will help the yarn to be pushed out and into the toilet bowl hopefully right so again to recap that what happened here sensory afferent neurons were activated due to stretch right it occurred right around 400 to 500 milliliters the bladder was really really stretching we had already held it two times at 200

and 300 milliliters we kept activating that pontine storage center at 400 and 500 it says all right I'm going to send these impulses down right so the first thing we did is we activated the sensory afferent fibers sent those impulses upwards right bypassing thoracolumbar region the spinal cord like the actual the preganglionic motor neurons then what do we do oh and then these motor neurons what should they actually come to the preganglionic the preganglionic should come out to a gang Leon this should be at a inferior mesenteric ganglion and again as they take these impulses

up they actually do what they give off some information to the pons and they give off this information to the cerebral cortex the cerebral cortex becomes aware of our desire to have to go to the bathroom what does it do it activates the cerebral cortex and tells the cerebral cortex to send these impulses down the third thing it does is it activates the pontine Declaration Center and inhibits the pontine storage center the pontine declaration center sends these impulses down and does what it inhibits the sympathetic preganglionic motor neurons which then we'll not send these action

potentials out to the inferior mesenteric ganglion which will not send the impulses out via the beta 3 action urgent receptors or to the alpha one adrenergic receptors if the beta 3 is not acted on right that's the fifth thing then the detrusor muscle will relax right I'm sorry will not relax it will not have any relaxation input so it'll actually want to contract because the parasympathetic nerves will take over right so this will no longer cause the action of the truss or muscle to relax the parasympathetic nerves will come over initiate contraction also it will

come over here to the internal urethral sphincter and it won't be able to release any norepinephrine on the alpha-1 adrenergic receptors then the internal urethral sphincter will relax and open up and allow for the urine to come out of the bladder at the urethra that was actually going to be the sixth thing the seventh thing is it comes over here and these descending fibers come and activate the preganglionic motor neurons of the parasympathetic region of the spinal cord rachel which is in the sacral region s 2 s 3 and s 4 these are stimulated they

send action potentials very heavily to an intramural ganglion which then sign axons on the m3 receptors which are located on the detrusor muscle right then it stimulates those smooth muscle cells to contract when the smooth muscle cells contract the bladder then starts contracting very heavily and trying to expel urine out not only that but this internal urethral sphincter was relaxed so the Eren can come out also then what did we say the urine was stuck here right at the urogenital diaphragm region right that was the urogenital diaphragm so right here with our urogenital diaphragm what

did we say happens we've said that the actual nicotinic receptors here what's going to happen these descending fibers from the pontine mcclure ition Center is going to come over here where to this actual somatic region of the spinal cord which is in the anterior grey horn it's going to activate the pudendal nerve right but in this situation we actually have to go to the bathroom we can't hold on to this thing anymore so what happens the descending fibers inhibit and if the 8 thing to happen inhibit the somatic motor neurons but inhibit the somatic motor

neurons within the and trigger horn the impulses are very very small or very a pretty much absent it no longer stimulates the nicotinic type 1 receptors and the external urethral sphincter starts relaxing and then urine can be evacuated and that is the process of voiding now when this urine comes out what is the composition of urine like you were talking about urine what is some of this composition of urine that you would expect so let's say that we take this whole urine drop here what is the composition of the urine that you would expect to

be there now generally urine is actually going to be about 95% water very little of it is going to consist of like sodium and potassium and chloride might have some calcium small amounts of calcium small amounts of magnesium a decent amount of urea which is actually a nitrogenous waste product remember it comes from the urea cycle which is the breakdown products of proteins you might even have a little bit of uric acid it might even be a little bit of uric acid which is actually a breakdown product from nucleic acids and there might be other

different chemicals that might be in this area right but in general nobody you might even have depending upon if you take in some medication there might be drugs there might be toxins there might be protons there might even be some bicarbonate a lot of stuff like that right but generally what is something that you do not find in a urine you generally don't find any proteins or any red blood cells or white blood cells and stuff like that right and that's why that's really bad if you ever did find stuff like that let's say by

some situation we take the remaining remnants of the urine and like this person has some actual components of the urine that are not normal like for example let's say that this person has this person's really he's all four w havin a bad day he's got let's say he got glucose in urine if he has glucose in the urine right why is that really bad because generally a hundred percent of our organic nutrients are reabsorbed within the proximal convoluted tubules if you find glucose in the urine this is called glycosuria but technically sentence glucose is called

glucose area if this happens this is usually an identifiable part for a condition called diabetes mellitus type 1 or type 2 alright then let's say that you find proteins in the urine so you find some proteins well proteins in the urine actually is sometimes it can actually be non pathological so let's say that you're you're exercising excessively so there's excessive exercise or you're pregnant in that situation you can have a normal small amounts of actual proteins within the area it's not pathological but then let's say it becomes pathological let's say that you have some type

of glomerular nephritis or let's say that you have high blood pressure or you have heart failure in these situations and what you have greater than 150 milligrams per day of protein in the urine this is the first sign of renal disease okay this is the first sign of renal disease that's why protein in the urine is dangerous if it becomes too high and too consistent right so if you do have really really high protein levels within the urine greater than hundred fifty milligrams per day it could be the first sign of brain disease and it

could be due to glomerulonephritis which is many many different types of which the glomerular basement membrane is affected and cause a lot of different fluids and substances to leak out high blood pressure and heart failure what if you found ketone bodies in the urine like acetyl acetate or beta hydroxy butyrate if you found ketone bodies in the urine they actually call this keto Maria whereas within proteins they call it protein area okay if you find ketones within the urine this could be due to uncontrolled diabetes mellitus so in other words the person's not taking their

insulin I'm about diabetes mellitus DM or it could be due to starvation you're not you haven't been eating properly so you're restricting a lot of your carbohydrate so you're just not eating food at all and your body starts breaking down fat reserves and accumulating a lot of acetyl co ways which shunts into ketogenesis or you're on a high-protein high fat diet and you're having no carbohydrates like the Atkins diet that can actually cause an excessive amount of ketosis to occur and they can get pushed out in the air what if you have bilirubin bilirubin in

the urine they call that Billy Ruben Maria Billy Ruben urea this is usually a sign of liver disease this is usually a sign of liver disease so in someone who has maybe cirrhosis or if they have hepatitis maybe some type of hepatitis whether it be hepatitis A a b c d e or it could be due to obstructions like gall stones if you have a goal stone blocking like the common bile duct or the common hepatic duct some of that bile can actually back flow into your systemic circulation and can get lost in the urine

that's another diagnostic tool another thing could be hemoglobin if you find hemoglobin in the urine they call this hemoglobinuria and this is really bad this usually means that someone has had has hemolytic anemia so if they have a hemolytic anemia like g6pd H deficiency or spherocytosis or whether it be sickle cell anemia some type of situation where the actual hemoglobin is being bursted i mean the red blood cells are bursting and releasing hemoglobin onto the actual circulation getting filtered across the glomerulus Oh in third-degree burns in third-degree burns this can also cause a lot of

hemoglobin to be lost in there and in certain situations in which you've had a transfusion that was mismatched so a mismatch transfusion so the many different cause is there what about what if you find these my red blood cells in here once you find our B C's in the urine if you find some erythrocytes in the urine they actually call this hematuria hematuria and hematuria is usually due to some type of tumor so maybe you have a carcinoma or maybe even polycystic kidney disease polycystic kidney disease or maybe there is some type of situation like

you have an infections through some part of the actual kidney for ample pyelonephritis or maybe it even be due to cystitis which is an inflammation or infection of the bladder and maybe it could be due to a lot of trauma sometimes if there's a significant amount of trauma to the actual kidneys this can also cause the actual red blood cells to get lost in here so it could be due to some type of tumor could be due to the excessive amounts of cysts that are forming like polycystic kidney disease could be due to infections could

be the trauma you notice is a very common cause kidney stones so kidney stones whether it be due to the oxalate of the calcium stones right calcium carbonate sodium oxalate stones they can get stuck whenever they're greater than five millimeters in diameter they commonly get stuck at the ureter and bladder junction okay and then what about if you have white blood cells in the urine if you have white blood cells in the air and they call that pi area and that's usually a sign of a UTI I have to get them on antibiotics right okay

so to sum everything up guys with this whole micturition reflex whenever the bladder is empty since we're a Ferren fibers are coming over to the actual what to the actual into the saiga region the spinal cord s2 s3 s4 what is it doing it's sending those impulses upwards to the thoracolumbar region the spinal cord stimulating the sympathetic motor neurons to come out and cause the bladder muscle to relax but cause the internal urethral sphincter to constrict this when our bladder is empty it also sends impulses up to the pond and the cerebral cortex to help

them become aware of our actual bladder volume when they're aware of it the pontine storage center is activated and then it's going to send these impulses down enhance the sympathetic outflow to cause the bladder muscle to relax and turn your research Viktor to contract it's also going to send impulses down to the parasympathetic motor neurons which will then cause the actual if these are inhibited they will not send impulses to cause the bladder to contract also it will activate the somatic motor neurons via the pudendal nerve to keep the extra narrator spanker constricted but then

as the urine starts accumulating to 200 mils and you keep activating the pontine storage center it goes up to 300 mils you keep activating the Ponting storage center it goes up to 400 500 milliliters nope can't do it anymore I got across the bladder to evacuate what does it do it activates the sensory afferent fibers of these actual pelvic nerves sends it into the dorsal region of the spinal cord from s2 s3 s4 sends those impulses upwards bypassing the thoracolumbar region where the sympathetic motor neurons are it goes up to the pond and the cerebral

cortex let's your cerebral cortex know that hey the bladder is pretty much full we definitely got to evacuate this bad boy the cerebral cortex says ok I'm going to send impulses down I'm going to stimulate the pontine micturition Center and inhibit the pontine storage center what happens is when the pontine micturition center sends these descending fibers down it inhibits the sympathetic motor neurons if you inhibit the sympathetic motor neurons they no longer try to keep the bladder relaxed so the sympathetic outflow is inhibited and that will allow for the parasympathetic outflow to stimulate the bladder

to contract another thing is if the sympathetic nervous system is inhibited the internal urethral sphincter will no longer be under stimulation it'll be under inhibition and then it will relax if it relaxes then the urine can come out another thing if the descending fibers from the pontine McClure Asian Center will stimulate the parasympathetic preganglionic motor neurons when these impulses are coming out they're going to be excessive firing of these axons remember it'll synapse on the intramural ganglia then order release the acetylcholine on to the muscarinic type 3 receptors which would cause the smooth muscle to

contract evacuating the bladder but again we said that the internal urethral sphincter was relaxed because the sympathetic outflow was inhibited as this relaxes then the urine will come down it's stopped by the external urethral sphincter if it's appropriate to urinate but again we've gone and held our bladder for a little bit too long more than we'd prefer we're up at 500 milliliters what's going to happen the actual primary I'm sorry the pontine my Christian Center will send the impulses down it'll inhibit the somatic motor neurons of the anterior horn and it'll inhibit the impulses out

through the pudendal nerve the somatic motor neurons which will no longer release acetylcholine onto the nicotinic receptors which will cause the external urethral sphincter to relax as it relaxes then what happens the urine is evacuating again we said a lot of the components of the urine it pretty much it's water some electrolytes a lot of urea uric acid sometimes there might be drugs toxins protons bicarbonate but it in what some of the things that you'd want to watch out for in the air and what you do not want to see there you do not want

to see glucose because that could mean diabetes mellitus you don't want to see proteins because if it's pathological it can mean glomerular nephritis it could mean blood pressure heart feelings usually the first sign of renal disease if you find ketone bodies it could be key to an area right it could be due to uncontrolled diabetes mellitus could be due to starvation or a very very low carb diet if you find bilirubin in the urine maybe think okay this person might have some type of liver disease maybe they have some type of hepatitis maybe they have

cirrhosis or even Gilbert syndrome or Gibble's gilbertson disease or they have some type of obstructive jaundice right if they find hemoglobin in the air and maybe so just look to see if they've had some type of mismatch transfusion or if they have some type of hemolytic anemia or if they have any type of third-degree burns recently and then again if you find white blood cells in the air and maybe think that this person might have white blood cells in here it's called pyuria they might have a urinary tract infection give them antibiotics and if you

find red blood cells or erythrocytes in the air it could be a hematuria could be due to a variety of things it could be due to trauma could be due to kidney stones could be due to some type of infection throughout the entire length of the urogenital tract or it could be the some type of tumor like maybe some type of renal carcinoma or even could be due to certain amounts of polycystic kidney disease if it gets really really severe okay I in those days in this video we covered a lot about mik duration I

really hope all of it made sense I hope you guys did enjoy if you did please hit the like button comment down in the comment section and always please subscribe all right edge nerds until next time