Renal Cases- Huzij

Question 1

What’s associated with the kidney?

Answer 1

Question 2

Osteopathic Principles

Answer 2

1. The human being is a dynamic unit of function
2. The body possesses self-regulatory mechanisms that are self-healing in nature
3. Structure and function are interrelated at all levels
4. Rational treatment is based on these principles.

Question 3

SD Definition

Answer 3

Impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial and myofascial structures, and their related vascular, lymphatic, and neural elements

Question 4

acute nephrolithiasis plan

Answer 4

Oral hydration, Opioid pain med, Ca Channel or Alpha 1 antagonist. Urology referral (Multiple stones or >5mm) OMM

Question 5

Urologic Anatomy

Answer 5

Kidneys are Retroperitoneal

R Kidney and Duodenum

L Kidney and Tail Pancreas,

Rib 11 and Internal Oblique, Rib 12 and Quadratus Lumborum

Other Structures:

Adrenals

Arcuate Ligaments

Rib 11 (L), Rib 12 (B)

Bladder, Ureters, Pubic Symphysis

Question 6

Urologic autonomics

Answer 6

SNS:

Kidney T10-L1 (T10-11)

Ureter T10-L1

Bladder T10-L2 (T12-L2)

Sup/Inf Mesenteric Ganglia

PNS: Kidney/Upper Ureter Vagus

Lower Ureter/Bladder S2-4

Question 7

OMM things to address

Answer 7

T10-L2, OA, Sacrum Lymphatics Sup/Inf Mesenteric Ganglia Psoas, Quad Lumb, Int Obl Diaphragm(s) Ribs 11(L) & 12(B) Kidney, Ureters

Question 8

ME: Internal Oblique & Quadratus Lumborum

Answer 8

Patient Prone, Stand opposite side to be treated Caudad hand grasp ASIS, Cephalad hand stabilize Rib 11 (then treat Rib 12 separately) Pull ASIS posteriorly, stabilize rib to barrier Patient pull ASIS to table, operator resist, stretch to new barrier, repeat x2-3 Treat bilaterally

Question 9

Re-dome Diaphragm

Answer 9

Direct Muscle Energy Barrier in sidebending and rotation Activating force inhalation (5 sec) Refine barrier on exhale Repeat x 2 Indirect MFR & Graduated Restrictive Techniques Also

Question 10

Iliacus (Psoas) Counterstrain

Answer 10

TP is 2 in inferior and 2 in medial from ASIS (press post-laterally) Pt: supine Technique: stand on tender side. Flex patient’s legs, externally rotate the legs and place them on your thigh. Flex, sidebend toward the TP until it resolves Hold for 90 sec Recheck

Question 11

Chapmans: Kidney

Answer 11

Ant: 2.5 cm Lateral and Superior to the Umbilicus Post: Between Transverse Processes of T12 & L1, bilaterally Tx: circular motion at point Treat Anterior than Posterior

Question 12

Visceral: Kidney

Answer 12

Start Lateral to Umbilicus on Medial border of Ascending/Descending Colon Move Cephalad until contact Anterior/Inferior aspect of Kidney Exhalation: Move kidney Cephalo-Medially Inhalation: Hold position Patient Supine Operator hand on patient’s quadratus lumborum providing anterior pressure Patient flexes, externally rotates, abducts, then extends ipsilateral hip Repeat 3-4 times