Osteopathic Considerations in the GU patient Flashcards
Which kidney is lower?
the right one! because of the liver….
What contacts the medial border of the kidneys?
Psoas muscle
What system relies a lot on diaphragm dysfunction?
the lymphatics
what spinal levels are the kidneys usually at?
the T12-L3 region
What is on the anterior surface of each kidney?
left: stomach
Right: liver
What muscle to the ureter pass on its way down?
the psoas muscle… so spasm of this=bad
-also touches the gen fem nerve
What is the sphincter, trigone, and urethral orifice activated by?
sympathetics T12-L2
-inhibited by parasympathetics (S2-3
What is the bladder wall activated/inhibited by?
activated by parasymp
inhibited by symp
what sends sympathetic fibers to the renal artery?
celiac plexus
What provides afferent and efferent innervation ot the Ureters?
Ureteric plexus
Where does afferent pain from stones come from?
T10 to L1
Where do the kidney and upper ureter sympathetics synapse?
Inferior mesenteric ganglion
Where does the bladder sympathetics synapse at?
inferior mesenteric ganglion
what does activation of the parasympathetic nervese S2-4 do?
contracts the bladder
what drug will people who have laxity in their bladders take?
an alpha adrenergic antagonist to block symp innervation from the hypogastric plexus
What is the somatic innervation to the External urethral sphincter?
pudendal nerves S2-4
- voluntary contraction can maintain closed EUS
- normal state is closed*
What inhibits the parasympathetics to control micturition?
the corticopontine-mesencephalic pathway
-frontal lobe inhibition of parasymp
What coordinates detrusor and sphincter interactoin?
Pontine mesencephalics sacral pathway
What happens with injury above the pontine center?
reduced inhibition of parasymp by frontal lobe
What happens with injury below the pontine center?
both detrusor and sphincters contract….. dyssynergia
-remember that we need that pontine mesencephalic sacral thing to coordinate detrusor and sphincter interaction
What mediates sacral parasymp reflex?
pelvic and pudendal nuclei
what would injury to pelvic and pudendal nuclei do?
give you areflexic bladder and urinary retention
What mediates voluntary control of the EUS?
Motor cortex to pudendal center
What provides parasympathetics to the kidney and proximal ureter?
vagus n.
What provides parasymp to distal ureter and bladder?
pelvic splanchnic nerves S2-4
what do lymphatics do in ureteral obstruction to preserve renal function?
they dilate!
How do the lymphatics help the kidney?
helps it concentrate urine!
Where does the diaphragm attach on the spine?
L1-2-3
In BPH, where are common dysfunctions found at?
T11-12 and L1
Where is stone pain referred to when it’s in the proximal half of the ureter?
the flank
stone in distal ureter, pain referral?
groin, testicle, labia
