The bladder lies in the anterior half of the PELVIS, bordered in front by the pubis bone and laterally by the side wall of the pelvis. Superiorly the bladder is covered by the peritoneal lining of the abdomen. The bottom or base of the bladder lies against the PROSTATE GLAND in the male and the UTERUS and VAGINA in the female.... urinary bladder
The bladder walls consist of muscle and an inner lining.
Two ureters carry urine to the bladder from the kidneys.
At the lowest point of the bladder is the opening into the urethra, which is known as the bladder neck.
This is normally kept tightly closed by a ring of muscle (the urethral sphincter).
The function of the bladder is to collect and store urine until it can be expelled.
Defective bladder function, leading to problems such as incontinence and urinary retention, can have a variety of causes.
(See also bladder, disorders of; enuresis).... bladder
Gall-bladder This is situated under the liver in the upper part of the abdomen, and its function is to store the BILE, which it discharges into the intestine by the BILE DUCT. For further details, see LIVER.
Urinary bladder This is situated in the pelvis, in front of the last part of the bowel. In the full state, the bladder rises up into the abdomen and holds about 570 ml (a pint) of urine. Two ?ne tubes, called the ureters, lead into the bladder, one from each kidney; and the urethra, a tube as wide as a lead pencil when distended, leads from it to the exterior – a distance of 4 cm (1••• inches) in the female and 20 cm (8 inches) in the male. The exit from the bladder to the urethra is kept closed by a muscular ring which is relaxed every time urine is passed.... bladders
Gall-stones affect 22 per cent of women and 11 per cent of men. The incidence increases with age, but only about 30 per cent of those with gall-stones undergo treatment as the majority of cases are asymptomatic. There are three types of stone: cholesterol, pigment and mixed, depending upon their composition; stones are usually mixed and may contain calcium deposits. The cause of most cases is not clear but sometimes gall-stones will form around a ‘foreign body’ within the bile ducts or gall-bladder, such as suture material. BILIARY COLIC Muscle ?bres in the biliary system contract around a stone in the cystic duct or common bile duct in an attempt to expel it. This causes pain in the right upper quarter of the abdomen, with nausea and occasionally vomiting. JAUNDICE Gall-stones small enough to enter the common bile duct may block the ?ow of bile and cause jaundice. ACUTE CHOLECYSTITIS Blockage of the cystic duct may lead to this. The gall-bladder wall becomes in?amed, resulting in pain in the right upper quarter of the abdomen, fever, and an increase in the white-blood-cell count. There is characteristically tenderness over the tip of the right ninth rib on deep inhalation (Murphy’s sign). Infection of the gall-bladder may accompany the acute in?ammation and occasionally an EMPYEMA of the gall-bladder may result. CHRONIC CHOLECYSTITIS A more insidious form of gall-bladder in?ammation, producing non-speci?c symptoms of abdominal pain, nausea and ?atulence which may be worse after a fatty meal.
Diagnosis Stones are usually diagnosed on the basis of the patient’s reported symptoms, although asymptomatic gall-stones are often an incidental ?nding when investigating another complaint. Con?rmatory investigations include abdominal RADIOGRAPHY – although many gall-stones are not calci?ed and thus do not show up on these images; ULTRASOUND scanning; oral CHOLECYSTOGRAPHY – which entails a patient’s swallowing a substance opaque to X-rays which is concentrated in the gall-bladder; and endoscopic retrograde cholangiopancreatography (ERCP) – a technique in which an ENDOSCOPE is passed into the duodenum and a contrast medium injected into the biliary duct.
Treatment Biliary colic is treated with bed rest and injection of morphine-like analgesics. Once the pain has subsided, the patient may then be referred for further treatment as outlined below. Acute cholecystitis is treated by surgical removal of the gall-bladder. There are two techniques available for this procedure: ?rstly, conventional cholecystectomy, in which the abdomen is opened and the gall-bladder cut out; and, secondly, laparoscopic cholecystectomy, in which ?breoptic instruments called endoscopes (see FIBREOPTIC ENDOSCOPY) are introduced into the abdominal cavity via several small incisions (see MINIMALLY INVASIVE SURGERY (MIS)). Laparoscopic surgery has the advantage of reducing the patient’s recovery time. Gall-stones may be removed during ERCP; they can sometimes be dissolved using ultrasound waves (lithotripsy) or tablet therapy (dissolution chemotherapy). Pigment stones, calci?ed stones or stones larger than 15 mm in diameter are not suitable for this treatment, which is also less likely to succeed in the overweight patient. Drug treatment is prolonged but stones can disappear completely after two years. Stones may re-form on stopping therapy. The drugs used are derivatives of bile salts, particularly chenodeoxycholic acid; side-effects include diarrhoea and liver damage.... gall-bladder, diseases of
Cystitis Most cases of cystitis are caused by bacteria which have spread from the bowel, especially Escherichia coli, and entered the bladder via the urethra. Females are more prone to cystitis than are males, owing to their shorter urethra which allows easier entry for bacteria. Chronic or recurrent cystitis may result in infection spreading up the ureter to the kidney (see KIDNEY, DISEASES OF).
Symptoms Typically there is frequency and urgency of MICTURITION, with stinging and burning on passing urine (dysuria), which is often smelly or bloodstained. In severe infection patients develop fever and rigors, or loin pain. Before starting treatment a urine sample should be obtained for laboratory testing, including identi?cation of the invading bacteria.
Treatment This includes an increased ?uid intake, ANALGESICS, doses of potassium citrate to make the urine alkaline to discourage bacterial growth, and an appropriate course of ANTIBIOTICS once a urine sample has been ana-lysed in the laboratory to con?rm the diagnosis and determine what antibiotics the causative organism is likely to respond to.
Stone or calculus The usual reason for the formation of a bladder stone is an obstruction to the bladder out?ow, which results in stagnant residual urine – ideal conditions for the crystallisation of the chemicals that form stones – or from long-term indwelling CATHETERS which weaken the natural mechanical protection against bacterial entry and, by bruising the lining tissues, encourage infection.
Symptoms The classic symptom is a stoppage in the ?ow of urine during urination, associated with severe pain and the passage of blood.
Treatment This involves surgical removal of the stone either endoscopically (litholapaxy); by passing a cystoscope into the bladder via the urethra and breaking the stone; or by LITHOTRIPSY in which the stone (or stones) is destroyed by applying ultrasonic shock waves. If the stone cannot be destroyed by these methods, the bladder is opened and the stone removed (cystolithotomy).
Cancer Cancer of the bladder accounts for 7 per cent of all cancers in men and 2·5 per cent in women. The incidence increases with age, with smoking and with exposure to the industrial chemicals, beta-napththylamine and benzidine. In 2003, 2,884 men and 1,507 women died of bladder cancer in England and Wales.
Symptoms The classical presenting symptom of a bladder cancer is the painless passing of blood in the urine – haematuria. All patients with haematuria must be investigated with an X-ray of their kidneys, an INTRAVENOUS PYELOGRAM (UROGRAM) and a cystoscopy.
Treatment Super?cial bladder tumours on the lining of the bladder can be treated by local removal via the cystoscope using DIATHERMY (cystodiathermy). Invasive cancers into the bladder muscle are usually treated with RADIOTHERAPY, systemic CHEMOTHERAPY or surgical removal of the bladder (cystectomy). Local chemotherapy may be useful in some patients with multiple small tumours.... urinary bladder, diseases of
Symptoms: Blood in the urine with absence of pain on passing water in early stages. Then, burning frequency, especially at night. Kidneys become involved. Growths range from papilloma to tumour which may ulcerate in later stages.
The lesion is confirmed by cystoscopy (examination of the bladder by insertion of an instrument to illuminate inner surfaces and makes possible a direct view of the affected tissues). Even when the condition is healed this examination is repeatedly necessary to detect recurrence.
Two kinds: (1) papillary epithelioma (2) squamous cell epithelioma.
Tea. Formula. Equal parts: Marshmallow root, Clivers, Horsetail, Shepherd’s purse. 1-2 teaspoons to each cup boiling water; infuse 10-15 minutes. 2 cups or more daily.
Decoction. Barberry bark cold infusion. 1 teaspoon to each cup cold water. Steep over night. 2 cups or more daily.
Tinctures. Formula. Horsetail 1; Clivers 2; Barberry 1. Mix. 1-2 teaspoons (5-10ml) 2 or more times daily. If inflammation is present add Meadowsweet 1.
Dr William Boericke, physician, advised Dandelion to lessen symptoms.
Diet. See: DIET – CANCER.
Supplements. Emphasis on Vitamins A and C. (Vitamin A in epithelial tumours, ‘New Scientist’ (1975) 303)
Treatment offered as a supportive to specific modern hospital techniques. Treatment by or in liaison with a general medical practitioner. ... cancer – bladder
Usually, there are also other defects, such as epispadias in males and failure of the pubic bones to join at the front.
Surgical treatment involves reconstructing the bladder and closing the abdominal wall.
If the bladder is very small, it is removed and the urine diverted (see urinary diversion).... exstrophy of the bladder
Acute or chronic. One of the commonest acute abdominal emergencies. An impressive rise in incidence in the young female population has been linked with the use of oral contraceptives. Other causes: heavy consumption of animal fats, sugars.
Symptoms. Severe upper abdominal pain, often radiating to the shoulder and right midback. Constancy of the pain contrasts with the repeated brief attacks of gall-stone (biliary) colic. Sweating, shallow erratic breathing, tenderness upper right abdomen, distension, flatulence, nausea, intolerance of fatty foods.
In cases of suspected cholecystitis, bitter herbs help liquefy bile and prevent consolidation. Prevention: Blue Flag, or Wild Yam, 2 tablets at night.
For infection: Echinacea.
Alternatives. BHP (1983) selection: Barberry, Mountain Grape, Balmony, Fringe Tree, Wild Yam, Wahoo, Chiretta, Dandelion, Black root; according to individual case. Milk Thistle.
Teas. Agrimony, Milk Thistle, Fumitory, Black Horehound, Wormwood. 1 heaped teaspoon to each cup boiling water, infuse 15 minutes. Half-1 cup freely.
Cold tea. One teaspoon Barberry bark to each cup cold water. Steep overnight. Half-1 cup freely. Tablets/capsules. Blue Flag. Echinacea, Wild Yam, Milk Thistle.
Powders. Equal parts: Echinacea, Wild Yam, Milk Thistle. Dose: 500mg (two 00 capsules, or one-third teaspoon) thrice daily.
Tinctures. Equal parts: Wild Yam, Blue Flag, Milk Thistle. 1 teaspoon thrice daily in water.
Topical. Castor oil pack over painful area.
Diet. Low fat. Avoid dairy products.
Supplementation. Vitamins A, B-complex, C. Bromelain, Zinc. Note. See entry: COURVOISER’S LAW. ... gall bladder, inflammation
Disturbed bladder control can also result from nerve degeneration in conditions such as diabetes mellitus, multiple sclerosis, or dementia. An unstable or irritable bladder is a common condition and is sometimes associated with a urinary tract infection or prolapse of the uterus. Tension or anxiety can cause frequent urination. In children, delayed bladder control (see enuresis) most often results from delayed maturation of the nervous system.... bladder, disorders of
Bladder cancer is more common in smokers and workers in the dye and rubber industries. Haematuria (blood in the urine) is the main symptom of bladder cancer. A tumour may obstruct the entry of a ureter into the bladder, causing back pressure and pain in the kidney region, or may obstruct the urethral exit, causing difficulty in passing, or retention of, urine.
Bladder tumours are diagnosed using cystoscopy and biopsy of the abnormal area. If small, they can be treated by heat or surgically during cystoscopy. They tend to recur at the same or other sites within the bladder, so that regular follow-up cystoscopy is needed. Bladder tumours that have spread through the bladder wall may be treated by radiotherapy or by surgical removal of part or all of the bladder.... bladder tumours
When sensation to pain is lost, abnormal stress and strain on a joint do not stimulate the protective reflex spasm of the surrounding muscles; this failure of the protective reflex allows exaggerated movement that can damage the joint. Osteoarthritis, swelling, and deformity are features of a neuropathic joint.An orthopaedic brace or caliper splint may be necessary to restrict any abnormal movement of the joint.
Occasionally, an arthrodesis (a surgical operation to fuse a joint) is performed.
The nerve damage is irreversible.... neuropathic joint
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