Osteopathic Considerations in Genitourinary Pt Flashcards
Functional disorders of the GU pt involve?
- Poor Posture
2. Compromised body mechanics
Flex posture can lead to…?
Increased abdominal pressure => pressure on:
liver
Kidney
Renal Fat pad compromised
What can Renal fat pad compromise cause?
- Passive congestion
- Hydronephrosis
- Urinary Stasis/Stones
- kinked ureters
Vertebral levels of kidney?
T-12 to L3
What kidney is lower?
Right
Are kidneys retroperitoneal?
yes
Do adrenals contact diaphragm?
yes, on superior surface
Medial border of kidney contacts?
The psoas
Lymphatics of kidney rely heavily on optimal function of?
Diaphragm
diaphragmatic dysfunction causes?
- Lower thoracics
- Ribs
- Quadratus lumborum spasm
- Hyperlordosis of lumbar spine
- Phrenic nerve dysfunction (C3-5)
Fascia surrounds kidney except what pole?
Inferior pole
R. Kidney:
Ant. surface covered by?
What else contacts?
- Liver
2. Descending Duodenum
L. Kidney:
Ant. Surface covered by?
- Stomach, spleen, colon, jejunum
Kidney is also involved in?
RBC production
ureter crosses what fascia and nerve?
- Psoas (spasm can lead to problems)
2. Genitofemoral nerve
Male urethra, 3 parts
- Prostatic part
- Pars Membranacea
- Pars Spongiosa
Sphinter, trigone and urethral orifice are activated by?
Inhb by?
- Sympathetics (T-12-L2)
2. Parasymp (S2-3)
Bladder wall activation by?
Parasympathetics
What controls flow of blood to kidneys?
Celiac plexus: symp fibers to renal A.
Pain from kidney stones goes to what V. levels and what plexus?
- T10 to L1
2. Ureteric Plexus
Kidney and upper ureter at what V. Levels and where is synapse?
- T10 - L1
2. Sup. Mesenteric ganglion
Where do fibers for lower ureter and bladder synapse?
- T12-L2
2. Inf. Mesenteric Ganglion
What controls micturation (urination)?
Parasymp: Pelvic Splanchnic S2-S4
What causes urine retention?
Sympathetics: Hypogastric plexus T10-L2
-Alpha adrenergic => relaxes detrusor
B2 => Closes Internal urethral sphincter
What do pudendal nerves control?
At s2-4
Voluntary urination: External urethral sphincter
2 Central pathways to control micturition?
- Corticopontine=mesencephalic
- Frontal lobe inhb of parasympathetics - Pontine mesencephalic sacral
- Coordinates detrusor and sphincter interaction - Pelvic and pudendal nuclei
- mediates sacral parasymp reflex
Inj. above pontine center =>?
Hyperreflexive bladder
Inj. Below pontine center =>?
Detrusor/sphincter contraction
-Sphincter dyssynergia
Inj. of pelvic and pudendal nuclei
Areflexic bladder and urinary retention
Parasymp of kidney and prox. ureter?
Vagus
Parasymp of distal ureter and bladder?
Pelvic splanchnic nerves (S2-4)
Lymphatics of Renal capsule and parenchyma?
Preaortic nodes
Lymphatics help the kidney do what?
Concentrate urine
Increased lymphatic congestion =>
decrease flow btw plasma and interstitium
Treatment approach Postural considerations: Diaphragm massages kidneys at?
L1-L3
Treatment approach Postural considerations: Psoas can decrease ___ and ___ kidneys from flexed posture?
- Lordosis
2. Compress
Treatment approach Postural considerations: Also consider ___ ___ in post wall of soma?
- Lower ribs
2. Quadratus lumborum
If you have a sympathetic urological problem what do you do?
TX T10-L2
- Reduce HPT
- Complet emptying
- Reduce ureterospasms
TX C2-C3 (Sup cervical ganglion
Deals w/ Inf. Mesenteric ganglion
Perform rib raising
TX for Lymphatics causing dysfunction?
- Open thoracic inlet and diaphragm
2. Rib raising and lymph pump
Tx. Parasymp problem?
OA/AA (Vagus)
OM Suture
Sacrum/pelvis
-S2-S4 for pelvic splanchnic
BPH dysfunctions found at?
T11-L1
Nephrolithiasis: Pain found where?
Prox = flank/costovertebral
Distal= groin, testicle, labia
How to preven Nephrolithiasis?
Hydration/diet
Nephrolithiasis: Common areas of dysfunction?
- T12-L2
2. S2-4
Pyelonephritis?
Same as Nephrolithiasis