Gu Omm Lecture 1

Front 1

T/F The kidney is retroperitoneal?

Back 1

TRUE

Front 2

How long, wide and deep is the kidney?

Back 2

12 cm long, 7 cm wide, 3cm deep

Front 3

Which kidney is larger?

Back 3

Left

Front 4

Which kidney is lower?

Back 4

right

Front 5

Where are the kidneys?

Back 5

deeply placed in the lower thoracic region- this is where your visceral somatics are located for the kidneys

Front 6

What muscle touches the medial aspect of the kidney?

Back 6

Psoas major

Front 7

What muscle touches the MIDDLE segment of the kidney?

Back 7

quadratus lumborum m

Front 8

What structure touches the lateral aspect of the kidney?

Back 8

area for aponeurosis of transverus abdominis muscle

Front 9

What are the 3 structures that touch the top of the left kidney?

Back 9

11th rib, area of diaphragm, 12th rib

Front 10

What are the 2 structures that touch the top of the right kidney?

Back 10

area of diaphragm and 12th rib

Front 11

In relation to the kidneys, how do the ureters descend?

Back 11

Ureters descend across the psoas fascia

Front 12

___ courses obliquely causing lateral displacement of the lower poles of the kidney

Back 12

Psoas

Front 13

Origin of Quadratus Lumborum?

Back 13

Iliolumbar ligament and iliac crest

Front 14

Attachment of Quadratus Lumborum?

Back 14

Tips of TP L1-L4 and Rib 12

Front 15

Action of Quadratus Lumborum?

Back 15

draws down the 12th rib, and acts as a muscle of inspiration by helping to fix the origin of the diaphragm

Front 16

Considered inferior extension of abdominal diaphragm

Back 16

Quadratus Lumborum

Front 17

quadratus spasm =

Back 17

Flattened diaphragm

Front 18

Continuous with lateral crus of the diaphragm

Back 18

Medial Arcuate Ligament

Front 19

Thoracic sympathetic chain ganglia are segmentally located in fascias _____

Back 19

over each rib head

Front 20

Rib raising starts as ___ but then the longer lasting effect becomes ____

Back 20

sympathetic outflow, decreasing sympathetic tone with reflex inhibition by MEDULLA

Front 21

Purpose of rib raising?

Back 21

Treats lympatic congestion, decrease sympathetics

Front 22

Visceral stimuli producing patterns of reflex response in segmentally related somatic structures

Back 22

Viscero-somatic Reflex

Front 23

reflex points (anterior and posterior) related to visceral pathology

Back 23

Chapman’s Reflex

Front 24

Somatic stimuli producing patterns of reflex response in segmentally related visceral structures

Back 24

Somato-visceral Reflex

Front 25

Somatic stimuli producing patterns of reflex response in segmentally related somatic structures

Back 25

Somato-somatic Reflex

Front 26

Visceral stimuli producing patterns of reflex response in segmentally related visceral structures

Back 26

Viscero-visceral Reflex

Front 27

Sympathetic chain ganglia located ___to rib heads

Back 27

anterior

Front 28

Sympathetic nervous system involved in which 2 reflexes?

Back 28

Somato-visceral reflex and Viscero-somatic reflex

Front 29

Reflex phenomenon produce palpable changes which osteopathic physicians can diagnose and treat

Back 29

Facilitated segment

Front 30

A peripheral focus of irritation…from the inflammation associated with visceral pathology

Back 30

Viscerosomatic Reflexes

Front 31

Impulses carried on afferent nerves back to the spinal cord at the corresponding spinal level

Back 31

Viscerosomatic Reflexes

Front 32

Some of the afferent signal reaches the somatic nerves innervating the Para spinal musculature can result in what dysfunctions?

Back 32

TART in segment, Facilitation. Type of Viscerosomatic Reflexes

Front 33

____ of systems at the SC level provides diagnostic clues of visceral SD, allows a way to treat the musculoskeletal system to affect the organ sympathetic hyperactivity

Back 33

cross talk

Front 34

This creates increased activity at the synapses at the cord level, therefore the threshold level is lowered. It is then more easily stimulated to discharge by impulses of sublevel intensity

Back 34

Facilitated Segments

Front 35

____ activity present in almost all disease due to facilitated segment(s).

Back 35

Hypersympathetic

Front 36

Take note however that below the level of the diaphragm, the Vagus nerve is ____

Back 36

80% afferent

Front 37

These are small nodular masses, palpable in soft tissue, that demonstrate sharp pinpoint non-radiating tenderness

Back 37

Chapman’s Reflexes

Front 38

Chapman’s Reflexes, Typically found in locations that are segmentally related to ___ innervation.

Back 38

visceral

Front 39

Chapman’s Reflexes, Thought to be the effect of the sympathetic nervous system upon segmentally related ____ vasculature

Back 39

lymphatic

Front 40

_____ from increased sympathetic tone, deep to the skin, in deep fascia or by periosteum, resulting in dysfunction in segmentally related lymphatic tissues.

Back 40

Gangliform congestion (hypercongestion) related to Chapman’s Reflexes

Front 41

Chapman’s Reflexes described as __, __, __, __ and their size is __

Back 41

Small, Smooth, Firm, Discreet. 2-3mm

Front 42

Where is the Anterior Kidney chapman reflex point?

Back 42

one inch lateral, one inch superior to the umbilicus ipsilaterally

Front 43

Chronic Kidney Disease, Affects up to ___ Americans (11%)

Back 43

20 million

Front 44

Over 70% of severe Chronic Kidney Disease is due to either ___ or ___

Back 44

Hypertension or Diabetes Mellitus

Front 45

What is the GFR when Chronic kidney disease is symptomatic?

Back 45

10-15ml/min

Front 46

What are the common complaints of Chronic Kidney Disease?

Back 46

fatigue, weakness, and malaise.

Front 47

What are the Gastrointestinal complaints of Chronic Kidney Disease?

Back 47

anorexia, nausea, vomiting, a metallic taste in the mouth, and hiccups are common

Front 48

Secondary issues concerns with Chronic Kidney Disease?

Back 48

anemia, acid-base problems, and Hyperkalemia

Front 49

What does the Ultrasound show in Chronic Kidney Disease?

Back 49

Small echogenic kidneys

Front 50

_____ renal fascia is thin and blends with the fascias of the circulatory system, but does not extend past the superior mesenteric artery

Back 50

Anterior renal fascia

Front 51

Posterior Renal Fascia is attached not only to the fascia of ____ and____, but also the fascias of the vertebrae and intervertebral discs

Back 51

Q. Lumborum, Psoas Major

Front 52

Above the adrenal gland, the two layers of renal fascia fuse and become contiguous with the ____

Back 52

diaphragmatic fascia

Front 53

Surrounds the kidneys and allows downward and lateral motion with inhalation

Back 53

RENAL FASCIA

Front 54

The___ fascia also envelops the ureter.

Back 54

inferior renal

Front 55

Sympathetics levels, nerves and ganglion for Small intestine, right colon, adrenals, gonads, kidney, upper half of ureter

Back 55

T10-T11 : (Lesser splanchnic nerve) -> Superior Mesenteric Ganglion

Front 56

Sympathetics levels, nerves and ganglion for Left colon, lower half of ureter, bladder, genitalia

Back 56

T12 (Least Splanchnic nerve) and L1-2 (Lumbar splanchnic nerve) -> Inferior Mesenteric Ganglion

Front 57

Parasympathetics for Kidney and proximal portion of ureters

Back 57

Vagus

Front 58

Parasympathetics for Distal portion of ureters, bladder

Back 58

S2-4: (via Pelvic Splanchnic nerves)

Front 59

Superior vagal ganglion sits in the ____. Inferior vagal ganglion sits around body of __ .

Back 59

jugular foramen, C2

Front 60

Inferior vagal ganglion sits around ____

Back 60

body of C2

Front 61

Parasympathetic effects on Ureters?

Back 61

Maintain normal peristalsis

Front 62

____ nerves control the bladder wall musculature

Back 62

Parasympathetic

Front 63

___ Nerve is the voluntary control for the external urethral sphincter

Back 63

Pudendal

Front 64

____ relaxation of the internal sphincter must also occur for voiding to take place

Back 64

Sympathetic

Front 65

Renal lymphatics flow into the ___ nodes before traveling up the ___to the subclavian vein

Back 65

pre-aortic, thoracic duct

Front 66

phrenic nerve takes its origin from ___

Back 66

C3-C5

Front 67

Synchronous motion of the ___ and ___ diaphragms is vital to lymphatic drainage from the urinary system.

Back 67

thoracic and pelvic

Front 68

Occurs as a result of a visceromotor reflex which causes increased tone to the thoracolumbar junction

Back 68

Lloyd’s Test

Front 69

V-levels for Diaphragmatic attachment

Back 69

L1-L3

Front 70

Psoas contracture can increase lumbar ____

Back 70

lumbar lordosis

Front 71

Psoas Dysfunction can affect fascial pulls and restrict ___ and ___ motion

Back 71

kidney and ureter

Front 72

Viscerosomatic reflexes will progress from __to __ region if calculi passing through ureter

Back 72

T10 to Lumbar

Front 73

OMT TREATMENT Goal DIRECTED AT SYMPATHETICS for levels of T10-L1

Back 73

Normalize sympathetic activity of Kidney and ureters

Front 74

OMT TREATMENT Goal DIRECTED AT SYMPATHETICS for levels of T12-L2

Back 74

Normalize sympathetic activity of bladder

Front 75

OMT TREATMENT GOAL DIRECTED AT PARASYMPATHETICS for OA, AA, Cranial

Back 75

Normalize parasympathetic output via the Vagus nerve

Front 76

OMT TREATMENT GOAL DIRECTED AT PARASYMPATHETICS for S2-S4, Sacrum, SI Joints

Back 76

Normalize parasympathetic output at Pelvic Splanchnic Nerves

Front 77

CHAPMAN’S VISCEROSOMATIC REFLEXES for Anterior Adrenals?

Back 77

One inch lateral and two inches superior to the umbilicus ipsilaterally

Front 78

CHAPMAN’S VISCEROSOMATIC REFLEXES for Posterior Adrenals?

Back 78

Intertransverse space on both sides of T11 and T12 midway between the spinous processes and transverse processes

Front 79

CHAPMAN’S VISCEROSOMATIC REFLEXES for Anterior Kidneys?

Back 79

One inch lateral and one inch superior to umbilicus ipsilaterally

Front 80

CHAPMAN’S VISCEROSOMATIC REFLEXES for Anterior Bladder?

Back 80

Umbilical area

Front 81

CHAPMAN’S VISCEROSOMATIC REFLEXES for Posterior Bladder?

Back 81

Intertransverse space (midway between spines and transverse process tips of L1-2 and T12-L1 respectively

Front 82

____ can exaggerate lumbar lordosis and cause a fascial pull which will affect the motion of the kidney and the ureters

Back 82

Psoas spasm

Front 83

URINARY TRACT INFECTIONS Symptoms?

Back 83

Fever, Chills, Nausea, Fatigue, Urinary frequency or burning and Pain

Front 84

Symptoms of UTI in Bladder area

Back 84

Suprapubic pain

Front 85

Why treat S2-S4 with OMT for UTI?

Back 85

Normalize Parasympathetic Activity – Pudendal Nerves

Front 86

What are the 3 functions of the kidney?

Back 86

controls volume and body fluid composition
forms urine
blood pressure control

Front 87

Covers the quadratus
Spans from L1 to midpoint of rib 12

Back 87

Lateral Arcuate Ligament

Front 88

Progressive azotemia over months to years.
Symptoms and signs of uremia when nearing end-stage disease.
Hypertension in the majority.
Bilateral small kidneys on ultrasound are diagnostic.
Blood Urea Nitrogen (BUN) and Creatinine Levels can be used to follow progression of the disease.

Back 88

Chronic Kidney Disease

Front 89

What is the BUN and Creatine in Chronic Kidney Disease?
What other sign is there?

Back 89

BUN-8-20 mg/dL, also increased in urinary obstruction (postrenal), dehydration, shock, burns, CHF, GI BLEEDING
Creatinine-0.6-1.2 mg/dL

Front 90

What is the UA like in Chronic Kidney Disease?

Back 90

Inability to concentrate or dilute urine appropriately
Broad Waxy Casts

Front 91

These all can cause? Glomerulonephritis
Acute Tubular Necrosis
Drug effects
Tumor Lysis syndrome
Dehydration
Rhabdomyolysis

Back 91

Some causes of Acute Renal Failure

Front 92

Vasoconstriction of afferent arterioles
Decreased GFR
Results in Decreased Urine Volume
Decreased Ureteral Peristalsis
May cause ureteral spasm
Relaxation of the bladder wall (Detrusor muscle)
Hypersympathetic tone can cause a functional urinary retention
May lead to vesicoureteral reflux

Back 92

Sympathetic effects on Renal Physiology

Front 93

Facilitates contraction of the Trigone muscle
Stimulates internal urethral sphincter to remain tightly closed
Inhibits parasympathetic stimulation
Micturition reflex is inhibited
Response is exacerbated by emotional stress

Back 93

Sympathetic effects on Renal Physiology

Front 94

Parasympathetic Effects on Bladder?
Maintains bladder wall ____
____ to detrusor muscle
____ to trigone muscle

Back 94

Maintains bladder wall tonicity
Excitatory to detrusor muscle
Inhibitory to trigone muscle

Front 95

Path of Lymphatic Drainage of Kidneys

Back 95

Intrarenal plexi
→ lateral aortic nodes
→ thoracic duct
→ left lymphatic duct
→ subclavian vein

Front 96

What is the goal in OMT with kidney problems?

Back 96

Eliminate somatic dysfunction and its related effect on the neural, lymphatic and vascular elements
Encourages maximal function

Front 97

5 points OMT can treat in sympathetics for GU

Back 97

T10-L1
T12-L2
Chapman’s Reflex Points
Rib Raising
Inferior Mesenteric Ganglion

Front 98

SPECIFIC DYSFUNCTIONS FROM T11 THROUGH SACRUM:
Treating T11-T12 DYSFUNCTIONS can result in?

Back 98

Improves arterial, venous and lymphatic circulation
Relieves Tension in Psoas and Deep Pelvic Muscles

Front 99

SPECIFIC DYSFUNCTIONS FROM T11 THROUGH SACRUM: Lumbar DYSFUNCTIONS

Back 99

Paravertebral Relaxation
Lumbar Muscles support the spinal column
Affected by all body motions
Viscerosomatic

Front 100

OMT GOAL in RENAL DISEASE for Lymphatics

Back 100

Maximize renal drainage via the thoracic and pelvic diaphragms
Diaphragm
First Rib Restrictions
Anterior cervical fascia (Sibson’s fascia)-Thoracic inlet
Lymphatic Pump
Rib Raising
Cervicothoracic Junction

Front 101

OMT GOAL in RENAL DISEASE for DIRECT TREATMENT OF THE KIDNEY (Visceral Manipulation)

Back 101

Direct kidneys up and out
Relaxes surrounding blood vessels, nerves and lymphatics
May also relax tissues around the ureters

Front 102

OMT GOAL in Congenital and Developmental Abnormalities

Back 102

Fascial Release
Diaphragm
Increase circulation and lymphatic drainage thereby maintaining optimal renal function and delaying symptoms of uremia in an irreversible condition

Front 103

Symptoms of UTI in Kidney(Pyelonephritis) area

Back 103

Lower thoracic pain or Flank Pain.
Can occur as a primary infection or due to an obstruction

Front 104

Why treat T10-L2 with OMT for UTI?

Back 104

Normalize Sympathetic Activity
Decreased tissue congestion and adequate tissue antibiotic level

Front 105

Difference between Intrinsic and Extrinsic Urinary Tract Obstruction?

Back 105

Intrinsic: Within the urinary tract
Extrinsic: Secondary to an external compression

Front 106

OMT GOAL IN URINARY TRACT OBSTRUCTION

Back 106

Decrease ureteral spasm
Palliative until passes or surgery (calculi or neoplasm)
Sonic disruption or surgical extraction

Front 107

TUMORS IN THE URINARY TRACT Presenting symptom?

Back 107

Vague pain, hematuria, pelvic obstruction
Misdiagnosis delays treatment

Front 108

OMT when used cautiously in RENAL NEOPLASM

Back 108

Sustain the overall body function
Prevent complications
Control Nausea
Reduce backache
Reduce ureteral pain caused by metastasis

Front 109

OMT directed at what in RENAL NEOPLASM

Back 109

Active connective tissue techniques to thoracic, lumbar, sacral areas
Relieve spasm, tension
Aid in bowel function
Sacral Parasympathetics