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OS III Test 1 > OAT Renal > Flashcards

OAT Renal Flashcards

1
Q

What causes cystitis?

A

Cause: Usually Bacteria

• Population at Highest Risk:

– Sexually active women

– Infants

– Pregnant women

– Elderly

– Catheter patients (most common nosocomial infection)

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2
Q

What sx make you think cystitis? what tests would you run to confirm?

A

• 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

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3
Q

How do we treat cystitis? what can happen if we don’t treat?

A

• Treatment:

– Appropriate Abx Therapy

– Increase fluid intake

– OMT as Tolerated

• Serious Complications:

– Pyelonephritis

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4
Q

If we see unexplained blood in the urine, what is the first dx until proven otherwise?

A

malignancy

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5
Q

What is the common term for nephrolithiasis?

A

kidney stones

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6
Q

How does nephrolithiasis present? most common stones?

A
  1. Severe colicky flank pain with radiation into the groin
  2. Calcium Oxalate, Calcium Phosphate
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7
Q

How do we dx nephrolithiasis?

A
  • UA –> looking for blood, crystals, signs of infection
  • CT without contrast

*stone analysis should be performed when possible

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8
Q

Why do we analyze stones?

A

based on the stone passed behavior modifications can help prevent future problems

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9
Q

How do we tx nephrolithiasis?

A
  • Conservative managment: aggressive hydration and dietary modification
  • Urologic Intervention undertaken when patients do not respond to conservative management
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10
Q

What behaviors help to avoid renal calculus formation?

A
  • 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)
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11
Q

What nerve is responsible for the pain with kidney stones?

A

genitofemoral n.

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12
Q

What is interstitial cystitis?

A

painful bladder syndrome

*more common in women

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13
Q

What sx make you think interstitial cystitis?

A

– 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

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14
Q

How do we dx interstitial cystitis? tx?

A
  1. H&P, bladder diary, pelvic exam, UA with cytology, Cystoscopy with biopsy, potassium sensitivity test
  2. 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

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15
Q

What normal changes do we see in the kidney with age?

A
  • 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

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16
Q

What are signs of renal failure?

A
  • 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
17
Q

What are general causes of renal failure?

A
  • impaired BF to kidneys (ex. NSAIDs, fluid loss)
  • kidney damage (ex. blood clot, toxins)
  • urine blockage in the kidneys (ex. cancer, BPH, kidney stone)
18
Q

How do we dx renal failure? tx?

A
  1. • Urine output measurements
  • Urine tests (UA)
  • Blood tests (BUN, Creatinine)
  • Imaging (US, CT)
  • Biopsy
  1. • Treat underlying cause (may include OMT)

• Treat complications until recovery (ex. IV fluids or diuretics)

19
Q

Explain following types of incontinence?

  1. stress
  2. urge
  3. overflow
  4. functional
  5. mixed
A
  • 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
20
Q

What causes incontinence?

A
  • 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)
21
Q

How do we dx incontinence?

A
  • Urinalysis
  • Bladder diary
  • Post-void residual
22
Q

How do we tx incontinence?

A
  • 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)
23
Q

The right kidney is related anteriorly to what organs? left kidney?

A

a. Liver, Duodenum, and Ascending Colon
b. Spleen, Pancreas, Stomach, and Descending Colon

24
Q

Sympathetic innervation

A

Kidney: T10-L1

Ureter: Upper 1⁄2= T10-L1; Lower 1⁄2= L1-L2

Bladder: T11-L2

Causes: Vasoconstriction, Ureteroconstriction, Constricts Internal Urethral Sphincter

25
Q

Parasympathetic innervation

A

Kidney: Vagus

Ureter: Upper 1⁄2= Vagus; Lower 1⁄2= S2-4

Bladder: S2-4

Helps with Peristalsis along Ureters

Contracts Bladder to urinate

26
Q

Anterior Chapman’s Points

a. Adrenals
b. Kidney/ureter
c. Bladder
d. Urethra

A
27
Q

Posterior Chapman’s Points

a. Adrenals
b. Kidney/ureter
c. Bladder
d. Urethra

A
28
Q

What is necessary for infectious process of respiratory circulation?

A

lymphatic drainage –> required for presentation of antigens to make antibodies and removal of inflammatory and cellular waste products

29
Q

How does the gut affect the bladder?

A
  • 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
30
Q

What neurologic areas affect the kidney?

A

– OA - Vagus (parasympathetic)

– T10 - L2 (sympathetic)

– Sacrum - pelvic splanchnics (parasympathetic)

31
Q

How can treating lower ribs affect the kidneys? what model is this?

A

a. remove mechanical restrictions around the kidney –> improved lymphatic drainage
b. Respiratory Circulatory (lympathic)

32
Q

How does OMT help with autonomic tone?

A

helps to normalize it

33
Q

What is a viscerosomatic reflex?

A

OS III Test 1 (25 decks)

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