Osteopathic Approach to the Renal Patient Flashcards
Imaging study of choice for suspected nephrolithiasis
Non-contrast CT
Most common stones causing nephrolithiasis
Calcium oxalate
Calcium phosphate
Signs and symptoms of interstitial cystitis
Pain in pelvis or between vagina and anus in women, or between scrotum and anus in men
Chronic pelvic pain, persistent urgent need to urinate, frequent urination of small amounts, pain or discomfort while bladder fills with relief after urinating, pain during sexual intercourse
Signs/symptoms of renal failure
Decreased urine output Fluid retention, causing swelling in legs, ankles, or feet Shortness of breath Fatigue Confusion Nausea Weakness Irregular heartbeat Chest pain or pressure Seizures or coma in severe cases
Incontinence characterized by dribbling of urine due to a bladder that doesn’t empty completely
A. Stress B. Urge C. Overflow D. Functional E. Mixed
C. Overflow
Incontinence characterized by leakage with pressure, i.e., cough, sneeze
A. Stress B. Urge C. Overflow D. Functional E. Mixed
A. Stress
Incontinence characterized by physical or mental impairment making it difficult to get to the toilet in time
A. Stress B. Urge C. Overflow D. Functional E. Mixed
D. Functional
Incontinence characterized by sudden, intense need to urinate, followed by involuntary loss of urine
A. Stress B. Urge C. Overflow D. Functional E. Mixed
B. Urge
Biomechanical considerations in a renal patient involve the fact that the kidneys are paired retroperitoneal organs, the uppor poles lie opposite the _____ vertebra, and lower pole lies opposite the ______ vertebra
The renal hila move by approx. ____ with breathing
T12; L3
3cm
Anatomic relationships to kidneys when considering biomechanical model
Right kidney: liver, duodenum, ascending colon anteriorly
Left kidney: spleen, pancreas, stomach, descending colon anteriorly
Posteriorly, both kidneys are adjacent to muscles and nerves of the posterior abdomen as well as diaphragm, pleura, and lungs
Note relationship between bladder, pelvis, sacrum, pelvic floor, and other organs
Sympathetic and parasympathetic innervation of kidneys - for consideration of neurologic model
Sympathetic:
T10-11
Lesser splanchnic nn.
Superior mesenteric ganglion
Parasympathetic:
Vagus n. (CN X)
Sympathetic and parasympathetic innervation of lower ureters, bladder, and pelvic organs - for consideration of neurologic model
Sympathetic:
T12-L2
Least/Lumbar splanchnic nn.
Inferior mesenteric ganglion
Parasympathetic:
Sacral (pelvic)
Splanchnic (S2-4)
Tx for collateral ganglia found to have fullness, bogginess, or increased tissue texture abnormalities
Direct inhibitory pressure with finger pads to feather’s edge of discomfort is maintained until release is observed
- Instruct pt to breath into your finger pads
- Follow the tissue release
Excessive distension of the ureter or spasm of its muscle may be caused by a stone and provokes severe pain (ureteric colic) that is spasmodic and agonizing. It is referred to cutaneous areas innervated from spinal segments which supply the ureter, mainly _______, and shoots down and towards groin, scrotum, or labium majus; it may extend into the proximal anterior aspect of the thigh by projection to the genitofemoral n.
T11-L2
Anterior Chapman’s reflexes associated with urinary system (adrenals, kidneys/ureters, bladder, and urethra)
Adrenals: 2-2.5” above and 1” lateral to umbilicus
Kidney/ureters: 1” above and 1” lateral to umbilicus
Bladder: periumbilical or umbilical
Urethra: inner edge of the pubic ramus near the symphysis
Posterior chapmans points associated with the urinary system: adrenals, kidneys, ureters, bladder, and urethra
Adrenals: intertransverse spaces between T11-12
Kidneys: intertransverse spaces between T12-L1
Ureters: intertransverse spaces between L1 and L2
Bladder and urethra: superior edge of L2 transverse process
Primary respiratory circulatory consideration for renal patients
Lymphatic drainage
[lymph vessels by the cortical radial arteries —> arcuate arteries —> interlobar arteries —> intrarenal plexi —> lateral aortic nodes —> thoracic duct: cysterna chyli to left subclavian vein]
Start at thoracic inlet, especially left. Examine and tx thoracoabdominal diaphragm. Examine and tx lower ribs to remove mechanical restrictions to lymph drainage. Examine and tx pelvic diaphragm. Pedal pump, if tolerated.
Primary metabolic/energetic consideration in a renal pt
Treat the gut to treat the bladder!
Constipation can cause bladder to have spasms on not empty completely; bladder sx may include day and night wetting, UTIs, frequency, urgency, and dysuria. It is very important to tx a child’s constipation so that bladder sx improve
Behavioral model management of a pt with cystitis
Increased fluid intake, take abx as directed
Behavioral model management of a pt with nephrolithiasis
Increased fluid intake, diet modifications as prescribed
Behavioral model management of a pt with interstitial cystitis
Diet modification, medications as directed
Behavioral model management of a pt with renal failure
Diet modification
Behavioral model management of a pt with incontinence
Bladder training, double voiding, scheduled toilet trips, fluid and diet management
Pelvic floor muscle exercises
Contraindications to OMT in renal pt
Pt is unable to tolerate OMT secondary to pain or positioning
Delaying more definitive care
