Pathophysiology of how an individual after spinal cord injury develops

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Pathophysiology of how an individual after spinal cord injury develops neurogenic bladder, bowel and autonomic dysreflexia:

Pathophysiology of how an individual after spinal cord injury develops neurogenic bladder, bowel and autonomic dysreflexia Presented by Archana Khadka S5074421

The Spinal Cord :

The Spinal Cord The spinal cord provides a two –way communication between the brain and the body via ascending sensory and descending motor pathways (Rossignol, 2013).

The spinal cord injury:

The spinal cord injury The spinal cord injury involves both primary damage, occuring at the time of impact and secondary damage that occurs due to pathophysiologic process that follows post impact (Sabharwal, 2014).

The spinal cord injury- Cont.:

The spinal cord injury- Cont. The spinal cord injury leads to: Interruption to the sensory and motor messages to and from the brain Results in loss of movements, sensation and autonomic control below the level of the cord damage. Severity of disability depends on where the spinal cord is damaged. (Rodger, 2016)

Neurogenic Bladder:

Neurogenic Bladder The neurogenic bladder is defined “as the abnormal function of the urinary bladder secondary to any neurologic condition of the central nervous system or the pheripheral nerves involved in the control of micturition” (Edokpolo, 2012).

Neurogenic bladder due to spinal cord injury:

Neurogenic bladder due to spinal cord injury Spinal cord injury can affect both- - Urine storage - Voiding When an injury occurs above the reflex voiding centre in the sacral area of the spinal cord usually thoracic T12 or above, the individual will lose the sensation of voiding and their voluntary control over the reflex voiding centre. (Hu, Granger & Jeffery, 2016)

abnormal urine storage and voiding in spinal cord injury:

abnormal urine storage and voiding in spinal cord injury (Hu, Granger & Jeffery, 2016)

Neurogenic bowel:

Neurogenic bowel The neurogenic bowel can defined as “the loss of normal bowel function due to nerve injury, neurological disease or congenital defects of the nervous system” . Symptoms include combinations of faecal incontinence, constipation, abdominal pain and bloating (Worsoe, Rasmussen, Christensen & Krogh, 2013).

Neurogenic bowel due to spinal cord injury:

Neurogenic bowel due to spinal cord injury Injuries above T12, depending upon extent of severity causes loss of function, sensation and disruption of reflex pathways which results in neurogenic bowel Injuries above T12- reflex function preserved but sensation and voluntary function absent- reflex neurogenic bowel . Complete SCI below T12 – disruption of the reflex pathways - flaccid neurogenic bowel. ( Walker, 2009).

Pathophysiology of neurogenic bowel due to spinal cord injury:

Pathophysiology of neurogenic bowel due to spinal cord injury Braber-Ymker , Lammens , Putten & Nagtegaal , 2017)

Autonomic Dysreflexia:

Autonomic Dysreflexia Autonomic dysreflexia is an medical emergency that occurs in individuals with spinal cord injury at T6 or higher (Bullock & Hales, 2013). It is an acute complication of spinal cord injury, if not recognised early or left untreated, can be fatal (Essat, 2013). Autonomic dysreflexia is also know as autonomic hyperreflexia In Autonomic dysreflexia, sensory receptors below the lesion/ injury are stimulated (Craft & Gordon, 2015).

Symptoms of Autonomic dysreflexia:

Symptoms of Autonomic dysreflexia Severe hypertension Bradycardia Pounding headache Flushed or blotchy appearance of skin above the level of lesion Profuse sweating above the level of lesion Pallor below the level of lesion Nasal congestion (Essat, 2013)

Causes of autonomic dysreflexia:

Causes of autonomic dysreflexia Distended bladder (mainly due to catheter blockage or other form of outlet blockage) Distended bowel (mainly due to impaction or constipation) Ingrown toeneil / fracture below level of lesion Pressure sore/ contact burn/ scald/ sunburn Urinary tract infection/ bladder spasm Renal calculi/ bladder calculi Visceral pain/ trauma Pregnancy/ delivery Deep vein thrombosis/ Pulmonary embolism Severe anxiety/ emotional distress ( Essat , 2013)

Diagram illustrating how autonomic dysreflexia occurs in a person with spinal cord injury:

Diagram illustrating how autonomic dysreflexia occurs in a person with spinal cord injury Jeff Blackmer CMAJ 2003;169:931-935


Questions MCQ 1. Which level of the spinal cord is involved in neurogenic bladder? T6 or above T6 or lower T12 or lower T12 or above MCQ 2. Which of the following is not a symptom of autonomic dysreflexia ? Severe hypertension Tachycardia Sweating Pallor SA. 1. What are the most common causes of autonomic dysreflexia ?


Reference Blackmer J. (2003). Rehabilitation medicine: Autonomic dysreflexia . CMAJ , 169(9):931-935 . Braber - Ymker , M. D., Lammens , M., Putten , M. J.A.M. V., & Nagtegaal , I. D. (2017). The enteric nervous system and the musculature of the colon are altered in patients with spina bifida and spinal cord injury. Virchows Arch, 470: 175 – 184. DOI: 10.1007/s00428-016-2060-4 Bullock , S., & Hales, M. (2013). Principles of Pathosiology . Australia: Pearson Craft, A. J., & Gordan , J. C. (2015). Understanding pathosiology (2nd Ed.). Australia: Elsevier Edokpolo , L. U. (2012). Outcomes in the urologic management of neurogenic bladder in spinal cord injured patients. Available from ProQuest Central; ProQuest Dissertations & Theses Global. (1102815615). Retrieved from Essat , Z. (2003). Management of autonomic dysreflexia . Nursing Standard (through 2013), 17(32), 42-4. Retrieved from http:// Hu , H. Z., Granger, N ., & Jeffery, N. D. (2016). Pathophysiology, Clinical Importance, and Management of Neurogenic Lower Urinary Tract Dysfunction Caused by Suprasacral Spinal Cord Injury. Journal of Veterinary Internal Medicine, 30(5), 1575 – 1588. DOI:10.1111/jvim.14557 Nerve pathways to spinal cord. Retrieved from Rodger , S. (2016). Care of spinal cord injury in non-specialist settings. Nursing Times, 112(26), 12-15. Retrieved March 8, from Rossignol, S. (2013). Anatomy and physiology of the spinal cord. In M.G. Fehlings et al. ( Eds ) Essentials of Spinal Cord Injury Basic research to Clinical Practice. New York: Thieme Sabharwal, S. (2014). Essentials of spinal cord medicine. New York: Demos Medical Publishing The spinal cord injury. Retrieved from Walker , J. (2009). Spinal cord injuries: acute care management and rehabilitation. Nursing Standard, 23(42), 47-56 Worsoe , J., Rasmussen, M., Christensen, P., & Krogh, K. (2013). Neurostimulation for Neurogenic Bowel Dysfunction. Gastroenterology Research and Practice, 2013.

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