Lecture 1: Renal Patient

Question 1

Which vertebral levels are associated with the upper and lower pole of the kidneys?

Answer 1

• Upper pole at T12
• Lower pole at L3

Question 2

Which 3 muscles of the posterior abdomen are in close relationship with the kidneys?

Answer 2

• Quadratus lumborum
• Psoas major
• Transversus abdominis

Question 3

The autonomic innervation of the kidneys and upper half of ureter correlate with what vertebral levels?

Answer 3

T10-T11

Question 4

What is the sympathetic, paraysympathetic, and collateral ganglia associated with the kidneys?

Answer 4

• Sympathetic = Lesser Splanchnic
• Parasympathetic = Vagus
• Ganglia = Superior Mesenteric

Question 5

The autonomic innervation of the lower ureters, bladder, and pelvic organs are at what vertebral levels?

Answer 5

Lower ureters: L1-L2

Bladder: T11-L2

Question 6

What is the sympathetic, parasympathetic, and collateral ganglia associated with the lower ureters, bladder, and pelvic organs?

Answer 6

• Sympathetic = Least/Lumbar Splanchnic
• Parasympathetic = Sacral (pelvic) Splanchnic (S2-S4)
• Ganglia = Inferior Mesenteric

Question 7

Excessive distention of the ureter or spasm of its muscle due to a stone may cause referred pain from which spinal segments?

Answer 7

T11-L2

Question 8

What is the location of the Anterior and Posterior Chapman’s points for the Kidney/Ureters?

Answer 8

• Anterior = 1’’ above and 1’’ lateral to umbilicus
• Posterior:
• Kidney = Intertransverse spaces btw T12 and L1
• Ureters = Intertransverse spaces btw L1 and L2

Question 9

What is the location of the Posterior Chapman’s point for the Bladder/Urethra?

Answer 9

Superior edge of L2 TP

Question 10

What is the pathway of lymph flow from the intrarenal plexi to the left subclavian V.?

Answer 10

Intrarenal plexi –> lateral aortic nodes –> thoracic duct: cisterna chyli to L. subclavian vein

Question 11

Treatment of constipation in whom is very important so that bladder sx’s can improve?

Answer 11

A child

Question 12

What are 2 contraindications to OMT in the renal patient?

Answer 12

• Pt is unable to tolerate OMT secondary to pain or positioning
• Delaying more definitive care

Question 13

List 5 primary locations of SD which may cause a renal patient to be more susceptible to their disease?

Answer 13

• Rib
• Diaphragm
• Thoracic
• Lumbar
• Pelvic

Question 14

Which Anterior Thoracic (AT) tenderpoints should you consider for treating a renal patient?

Answer 14

AT 9-12

Question 15

Which posterior TP’s should you consider treating for a renal patient?

Answer 15

PT9-PL2

Question 16

Local osteopathic fascial manipulation was found to decrease pain perception and what aspect of the kidney?

Answer 16

Improvement of kidney MOBILITY

Question 17

Referred pain from the ureter may extend into the proximal anterior aspect of the thigh by projection to what nerve (L1, L2)

Answer 17

Genitofemoral nerve

Question 18

After passing a stone, you recommend to a patient that he should drink plenty of water and avoid soft drinks/tea, which osteopathic model does this fall under?

Answer 18

Behavioral

Question 19

Prescribing antibiotics as part of the tx regimen for pt with pyelonephritis is focusing on which osteopathic model (5-models)?

Answer 19

Metabolic Energetic