Osteopathic Considerations in the GU patient

Question 1

Which kidney is lower?

Answer 1

the right one! because of the liver….

Question 2

What contacts the medial border of the kidneys?

Answer 2

Psoas muscle

Question 3

What system relies a lot on diaphragm dysfunction?

Answer 3

the lymphatics

Question 4

what spinal levels are the kidneys usually at?

Answer 4

the T12-L3 region

Question 5

What is on the anterior surface of each kidney?

Answer 5

left: stomach
Right: liver

Question 6

What muscle to the ureter pass on its way down?

Answer 6

the psoas muscle… so spasm of this=bad

-also touches the gen fem nerve

Question 7

What is the sphincter, trigone, and urethral orifice activated by?

Answer 7

sympathetics T12-L2

-inhibited by parasympathetics (S2-3

Question 8

What is the bladder wall activated/inhibited by?

Answer 8

activated by parasymp

inhibited by symp

Question 9

what sends sympathetic fibers to the renal artery?

Answer 9

celiac plexus

Question 10

What provides afferent and efferent innervation ot the Ureters?

Answer 10

Ureteric plexus

Question 11

Where does afferent pain from stones come from?

Answer 11

T10 to L1

Question 12

Where do the kidney and upper ureter sympathetics synapse?

Answer 12

Inferior mesenteric ganglion

Question 13

Where does the bladder sympathetics synapse at?

Answer 13

inferior mesenteric ganglion

Question 14

what does activation of the parasympathetic nervese S2-4 do?

Answer 14

contracts the bladder

Question 15

what drug will people who have laxity in their bladders take?

Answer 15

an alpha adrenergic antagonist to block symp innervation from the hypogastric plexus

Question 16

What is the somatic innervation to the External urethral sphincter?

Answer 16

pudendal nerves S2-4

• voluntary contraction can maintain closed EUS
• normal state is closed*

Question 17

What inhibits the parasympathetics to control micturition?

Answer 17

the corticopontine-mesencephalic pathway

-frontal lobe inhibition of parasymp

Question 18

What coordinates detrusor and sphincter interactoin?

Answer 18

Pontine mesencephalics sacral pathway

Question 19

What happens with injury above the pontine center?

Answer 19

reduced inhibition of parasymp by frontal lobe

Question 20

What happens with injury below the pontine center?

Answer 20

both detrusor and sphincters contract….. dyssynergia

-remember that we need that pontine mesencephalic sacral thing to coordinate detrusor and sphincter interaction

Question 21

What mediates sacral parasymp reflex?

Answer 21

pelvic and pudendal nuclei

Question 22

what would injury to pelvic and pudendal nuclei do?

Answer 22

give you areflexic bladder and urinary retention

Question 23

What mediates voluntary control of the EUS?

Answer 23

Motor cortex to pudendal center

Question 24

What provides parasympathetics to the kidney and proximal ureter?

Answer 24

vagus n.

Question 25

What provides parasymp to distal ureter and bladder?

Answer 25

pelvic splanchnic nerves S2-4

Question 26

what do lymphatics do in ureteral obstruction to preserve renal function?

Answer 26

they dilate!

Question 27

How do the lymphatics help the kidney?

Answer 27

helps it concentrate urine!

Question 28

Where does the diaphragm attach on the spine?

Answer 28

L1-2-3

Question 29

In BPH, where are common dysfunctions found at?

Answer 29

T11-12 and L1

Question 30

Where is stone pain referred to when it’s in the proximal half of the ureter?

Answer 30

the flank

Question 31

stone in distal ureter, pain referral?

Answer 31

groin, testicle, labia