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OS3 Exam II > Osteopathic considerations in the genitourinary patient > Flashcards

Osteopathic considerations in the genitourinary patient Flashcards

1
Q

Functional disorders of the GU patient involve

A

-poor posture and compromised body mechanics

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2
Q

Flexed posture can

A
  • increase pressure in abdomen and put direct pressure on the liver
  • compresses the right kidney
  • renal fat pad compromised allowing drooping of kidney
  • passive congestion, hydronephrosis, urinary stasis/stones, ureters “kinked”
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3
Q

Kidney position

A
  • paravertebral
  • Position standing depends on habits but in supine position they usually lie T12-L3
  • right lower than left
  • retroperitoneal
  • adrenals lie on superor surface–in contact with the diaphragm
  • medial border of kidneys contacts psoas
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4
Q

Kidney fascias

A
  • retroperitoneal with associated fatty tissue
  • tough, surrounds all sides except inferior pole (diaphragmatic motion)
  • lymphatics rely heavily on optimal function of the diaphragm
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5
Q

Diaphragmatic dysfunction caused by

A

-lower thoracics, ribs, quadrates lumborum spasm, hyperlordosis of lumbar spine, and phrenic nerve dysfunction C3-5

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6
Q

Right kidney

A
  • anterior surface covered by liver

- also contacted by descending duodenum

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7
Q

Left kidney

A
  • anterior surface covered by stomach

- also spleen, colon, jejunum

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8
Q

Kidney function

A
  • controls volume and body fluid composition
  • forms urine
  • bp control
  • RBC production
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9
Q

Ureters

A
  • drain kidney
  • to bladder
  • travel across psoas fascia
  • cross genitofemoral nerve on way to bladder
  • psoas contracture or spasm may contribute to ureteral dysfunction or vice versa
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10
Q

Bladder

A
  • 3 orifices
  • two incoming–ureteric ostia
  • one outgoing–internal urethral orifice
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11
Q

Ureter musculature

A
  • detrusor is most of bladder

- small pubovesical muscle slips descend to bladder neck toward urethra

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12
Q

Female Urethra

A
  • 4 cm
  • approximates the anterior vaginal wall
  • passes through urogenital diaphragm
  • exits just anterior (ventral) to vagina
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13
Q

Male Urethra

A

20 cm

-3 parts: prostatic, paras membranacea, pars spongiosa

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14
Q

Prostatic urethra

A

-just distal to bladder, prostate surrounds

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15
Q

Pars membranacea urethra

A

-passes through urogenital diaphragm

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16
Q

Pars spongiosa urethra

A

-travels through corpus spongiosum of penis

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17
Q

Bladder

A
  • sphincter, trigone, and urethral orifice
  • activated by sympathetics (T12-L2)
  • inhibited by parasympathetics (S2-3)
18
Q

Bladder wall

A
  • activated by parasympathetics

- inhibited by sympathetic

19
Q

Celiac plexus

A
  • sympathetic fibers to renal artery (renal plexus)

- controls flow of blood to the kidneys

20
Q

Ureteric plexus

A
  • sympathetic afferent and efferent
  • afferent (pain from stones) to T10-L1
  • ureters
21
Q

Sympathetics: kidney and upper ureter

A
  • T10-L1
  • synapse in the superior mesenteric ganglion
  • fibers for lower ureter synapse in inferior mesenteric ganglion
22
Q

Sympathetics: Bladder

A

T12-L2

-synapse at inferior mesenteric ganglion

23
Q

PNS efferent control of micturation

A
  • pelvic splanchnic–S2-4
  • activation of nerves contracts bladder
  • causes emptying
24
Q

SNS efferent control of micturation

A
  • hypogastric plexus–T10-L2
  • activation of nerves relaxes bladder
  • causes retention
  • alpha adrenergic-relaxes detrusor
  • beta-2 adrenergic-closes internal urethral sphincter
25
Q

Somatic Innervation of kidney

A
  • pudendal nerves S2-S4
  • striated muscles at external urethral sphincter
  • voluntary contraction can maintain closed EUS
  • normal state is closed
26
Q

Voiding is partly:

A
  • Parasympathetic activation–detrusor contracts
  • Sympathetics relax IUS
  • abdominal pressure increases
  • passive pressure opens EUS
27
Q

Central pathways for micturition control: corticopontine-mesencephalic

A
  • frontal lobe inhibition of parasympathetics
  • injury above pontine center reduces inhibition
  • low bladder volume–hyperreflexic bladder
28
Q

Central pathway for micturition control: pontine mesencephalic sacral

A
  • coordinates detrusor and sphincter interaction
  • injury below pontine center: both detrusor and sphincters contract
  • detrusor–sphincter dyssynergia
29
Q

Central pathway for micturition control: pelvic and pudendal nuclei

A
  • mediates sacral parasympathetic reflex (full bladder stimulates parasympathetics, which contract detrusor)
  • injury leads to areflexic bladder
  • urinary retention
30
Q

Central Pathway for micturition control: motor cortex to pudendal center

A

mediates voluntary control of EUS

31
Q

Kidney and proximal ureter PNS

A

-vagus

32
Q

Distal ureter and bladder PNS

A
  • pelvic splanchnic nerves

- S2-4

33
Q

Urinary Lymphatics

A
  • renal capsule and parenchyma–preaortic nodes
  • in ureteral obstruction–lymphatics dilate to help preserve renal function
  • lymphatics help the kidney concentrate urine
34
Q

With lymphatic congestion

A

-increase in oncotic pressure in interstitium=decrease flow between plasma and interstitium

35
Q

Ambulatory Treatment of urinary organs

A
  • postural considerations
  • diaphragm massages kidneys
  • L1-L3 diaphragm attachment
  • Psoas spasm can decrease lordosis, compress kidneys from flexed posture, restrict ureters
  • lower ribs, quadrates lumborum–posterior wall of soma
36
Q

Urologic Dysfunction treatment of sympathetics

A

-rib raising
T10-L2 (kidney and bladder)–reduce stimulation to renal arteries (reduce component of HTN); reduce excessive relaxation of bladder (complete emptying); reduce ureterospasm of IUS (urinary retention)
-Inferior mesenteric ganglion
-Correct any dysfunction at C2-C3 (superior cervical ganglion)

37
Q

Urologic Dysfunction treatment of lymphatics

A
  • thoracic inlet and diaphragms
  • rib raising
  • lymphatic pump
  • pelvic diaphragm
  • Cervicothoracic junction–Scalenes, first rib
38
Q

Urologic dysfunction treatment of parasympathetics

A
  • OA/AA
  • OM suture
  • Sacrum/pelvis
  • S2-S4 (PNS to bladder–pelvic splanchnic nerve)
39
Q

Benign Prostatic Hypertrophy shows dysfunction at

A

T11-12

L1

40
Q

Nephrolithiasis Ureteral stone pain referral

A
  • proximal 1/2-flank, CVA
  • distal 1/2-groin, testicle, labia
  • prevention is very important concept–hydration, dietary
41
Q

Nephrolithiasis common ares of dysfunction

A
  • T12-L2
  • S2-4
  • may consider a psoas spasm affecting hip motion if ureter involved
42
Q

Pyelonephritis

A
  • same as for nephrolithiasis
  • frymann associated cervical dysfunction with renal dysfunction
  • OA/AA connections with vagus?

OS3 Exam II (10 decks)

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