OAT Renal Flashcards
What causes cystitis?
Cause: Usually Bacteria
• Population at Highest Risk:
– Sexually active women
– Infants
– Pregnant women
– Elderly
– Catheter patients (most common nosocomial infection)
What sx make you think cystitis? what tests would you run to confirm?
• Common Symptoms:
– Dysuria, Hematuria, Frequency, Urgency, Fever, Lower Abd Pain
• Tests:
– Midstream urinary analysis (UA), Lloyd’s Punch (R/O Pyelonephritis)
*unexplained blood in urine is malignancy until proven otherwise
How do we treat cystitis? what can happen if we don’t treat?
• Treatment:
– Appropriate Abx Therapy
– Increase fluid intake
– OMT as Tolerated
• Serious Complications:
– Pyelonephritis
If we see unexplained blood in the urine, what is the first dx until proven otherwise?
malignancy
What is the common term for nephrolithiasis?
kidney stones
How does nephrolithiasis present? most common stones?
- Severe colicky flank pain with radiation into the groin
- Calcium Oxalate, Calcium Phosphate
How do we dx nephrolithiasis?
- UA –> looking for blood, crystals, signs of infection
- CT without contrast
*stone analysis should be performed when possible
Why do we analyze stones?
based on the stone passed behavior modifications can help prevent future problems
How do we tx nephrolithiasis?
- Conservative managment: aggressive hydration and dietary modification
- Urologic Intervention undertaken when patients do not respond to conservative management
What behaviors help to avoid renal calculus formation?
- Minimum intake of 2 L water/day
- Avoid strictly vegetarian diets
- Avoid excessive animal protein diets, salt consumption, vitamin C/D consumption, soft drinks
- consume phytate-rich foods (such as bran, legumes, beans, wild rice, Brazil nuts)
What nerve is responsible for the pain with kidney stones?
genitofemoral n.
What is interstitial cystitis?
painful bladder syndrome
*more common in women
What sx make you think interstitial cystitis?
– Pain in the pelvis, between the vagina and anus, between the scrotum and anus
– A persistent, urgent need to urinate
– Frequent urination
– Pain or discomfort while the bladder fills and relief after urinating
– Pain during sex
How do we dx interstitial cystitis? tx?
- H&P, bladder diary, pelvic exam, UA with cytology, Cystoscopy with biopsy, potassium sensitivity test
- PT, NSAIDS, Tricyclic antidepressants, antihistamines (decrease urgency and frequency), Pentosan polysulfate sodium* (Elmiron; possibly helps restore the inner surface of the bladder), OMT
*Elmiron; possibly helps restore the inner surface of the bladder; may take 2-4 months to notice relief
*no tx is definitive
What normal changes do we see in the kidney with age?
- Decreased GFR
- Glomerular, vascular, and accompanying parenchymal changes occur
- The number of nephrons is reduced, and creatinine clearance declines
*have to be careful with drug toxicity
What are signs of renal failure?
- Decreased urine output
- Fluid retention
- Shortness of breath
- Fatigue (ex. anemia)
- Confusion (ex. acidosis, electrolyte imbalance)
- Nausea
- Weakness
- Irregular heartbeat
- Chest pain or pressure
- Seizures or coma in severe cases
What are general causes of renal failure?
- impaired BF to kidneys (ex. NSAIDs, fluid loss)
- kidney damage (ex. blood clot, toxins)
- urine blockage in the kidneys (ex. cancer, BPH, kidney stone)
How do we dx renal failure? tx?
- • Urine output measurements
- Urine tests (UA)
- Blood tests (BUN, Creatinine)
- Imaging (US, CT)
- Biopsy
- • Treat underlying cause (may include OMT)
• Treat complications until recovery (ex. IV fluids or diuretics)
Explain following types of incontinence?
- stress
- urge
- overflow
- functional
- mixed
- Stress - leakage with pressure on the bladder (ex. cough, sneeze)
- Urge - sudden, intense urge followed by involuntary loss of urine
- Overflow - Dribbling of urine due to a bladder that doesn’t empty completely
- Functional - physical or mental impairment makes it difficult to get to the toilet in time
- Mixed – mixed
What causes incontinence?
- Temporary – ingestion of substances that may stimulate the bladder or increase urine volume (alcohol, chili peppers, heart meds)
- Persistent – underlying physical problem or change (pregnancy, enlarged prostate, cancer, neurologic disorders)
How do we dx incontinence?
- Urinalysis
- Bladder diary
- Post-void residual
How do we tx incontinence?
- Behavioral (ex. bladder training, scheduled toilet trips)
- Pelvic floor muscle exercises
- Electrical stimulation
- Medications – Anticholinergics, Mirabegron (urge), alpha blockers (prostate), topical estrogen
- Medical devices
- Interventional therapies
- Surgery
- OMT (especially with stress)
The right kidney is related anteriorly to what organs? left kidney?
a. Liver, Duodenum, and Ascending Colon
b. Spleen, Pancreas, Stomach, and Descending Colon
Sympathetic innervation
Kidney: T10-L1
Ureter: Upper 1⁄2= T10-L1; Lower 1⁄2= L1-L2
Bladder: T11-L2
Causes: Vasoconstriction, Ureteroconstriction, Constricts Internal Urethral Sphincter
Parasympathetic innervation
Kidney: Vagus
Ureter: Upper 1⁄2= Vagus; Lower 1⁄2= S2-4
Bladder: S2-4
Helps with Peristalsis along Ureters
Contracts Bladder to urinate
Anterior Chapman’s Points
a. Adrenals
b. Kidney/ureter
c. Bladder
d. Urethra
Posterior Chapman’s Points
a. Adrenals
b. Kidney/ureter
c. Bladder
d. Urethra
What is necessary for infectious process of respiratory circulation?
lymphatic drainage –> required for presentation of antigens to make antibodies and removal of inflammatory and cellular waste products
How does the gut affect the bladder?
- Constipation can cause the bladder to have spasms and not empty completely
- Bladder symptoms that can occur with constipation are day and night wetting, UTIs, frequency, urgency and pain with urination
What neurologic areas affect the kidney?
– OA - Vagus (parasympathetic)
– T10 - L2 (sympathetic)
– Sacrum - pelvic splanchnics (parasympathetic)
How can treating lower ribs affect the kidneys? what model is this?
a. remove mechanical restrictions around the kidney –> improved lymphatic drainage
b. Respiratory Circulatory (lympathic)
How does OMT help with autonomic tone?
helps to normalize it
What is a viscerosomatic reflex?
